Of these patients with bilateral imaging findings, only 21% had bilateral clinical symptoms or findings suggestive of TOS. Therefore, MRV has the potential to overdiagnose vTOS, and clinical symptoms must be taken into account. MRV may also be performed in the postintervention setting to evaluate interval changes in the thoracic outlet, assess adequate decompression, and confirm arterial patency. Radiography Chest Because of the importance of identifying osseous structures that may impinge on the spaces of the thoracic outlet, chest radiography is useful in performing a robust evaluation for all types of TOS. As opposed to directly evaluating vascular structures, osseous abnormalities associated with TOS are frequently easily diagnosed by chest radiographs. These include first rib anomalies [20], cervical ribs [23], congenital osseous malformations [24,25], and focal bone lesions [26]. In the postoperative setting, radiographs may be useful to confirm osseous changes and evaluate for postoperative complications such as pneumothorax. US has a longstanding and well-documented role in the diagnosis of upper-extremity DVT [5,39], a common presentation of vTOS in the acute setting. Although the main advantage of US is the ability to directly compare between provocatively induced symptoms and concurrent direct vessel visualization, there is debate in the literature as to the significance of imaging findings, particularly with respect to maneuvers to minimize the thoracic outlet and associated spaces [28,37,40]. It is important to consider that certain etiologies of vTOS due to deeper pathology, such as Pancoast tumor or cervical spondylopathy, may require further investigation with cross-sectional imaging. Thoracic Outlet Syndrome In the postoperative setting, US can be useful to evaluate vessel patency and complications, such as postoperative hematoma or fluid collection. Variant 3: Arterial thoracic outlet syndrome. Initial imaging and follow-up imaging after surgery or intervention.
Thoracic Outlet Syndrome. Of these patients with bilateral imaging findings, only 21% had bilateral clinical symptoms or findings suggestive of TOS. Therefore, MRV has the potential to overdiagnose vTOS, and clinical symptoms must be taken into account. MRV may also be performed in the postintervention setting to evaluate interval changes in the thoracic outlet, assess adequate decompression, and confirm arterial patency. Radiography Chest Because of the importance of identifying osseous structures that may impinge on the spaces of the thoracic outlet, chest radiography is useful in performing a robust evaluation for all types of TOS. As opposed to directly evaluating vascular structures, osseous abnormalities associated with TOS are frequently easily diagnosed by chest radiographs. These include first rib anomalies [20], cervical ribs [23], congenital osseous malformations [24,25], and focal bone lesions [26]. In the postoperative setting, radiographs may be useful to confirm osseous changes and evaluate for postoperative complications such as pneumothorax. US has a longstanding and well-documented role in the diagnosis of upper-extremity DVT [5,39], a common presentation of vTOS in the acute setting. Although the main advantage of US is the ability to directly compare between provocatively induced symptoms and concurrent direct vessel visualization, there is debate in the literature as to the significance of imaging findings, particularly with respect to maneuvers to minimize the thoracic outlet and associated spaces [28,37,40]. It is important to consider that certain etiologies of vTOS due to deeper pathology, such as Pancoast tumor or cervical spondylopathy, may require further investigation with cross-sectional imaging. Thoracic Outlet Syndrome In the postoperative setting, US can be useful to evaluate vessel patency and complications, such as postoperative hematoma or fluid collection. Variant 3: Arterial thoracic outlet syndrome. Initial imaging and follow-up imaging after surgery or intervention.