Ultrasonographic assessment of arterial cross-sectional area in the thoracic outlet on postural maneuvers measured with power Doppler ultrasonography in both asymptomatic and symptomatic populations.
ABSTRACT The purpose of this study was to evaluate the feasibility and potential usefulness of power Doppler ultrasonography (PDU) in the assessment of changes in arterial cross-sectional area in the thoracic outlet during upper limb elevation.
Forty-four volunteers and 28 patients with a clinical diagnosis of arterial thoracic outlet syndrome were evaluated by B-mode imaging and PDU. Arterial cross-sectional area was assessed in the 3 compartments of the thoracic outlet with the arm alongside the body and at 90 degrees, 130 degrees, and 170 degrees of abduction. The percentage of arterial stenosis was calculated for each of these arm positions. Nineteen of the 28 patients were also assessed by magnetic resonance (MR) imaging.
No significant arterial stenosis was shown in the interscalene triangle and in the retropectoralis minor space of the volunteers and patients. A significant difference (P < .01) in stenosis between volunteers and patients was seen for all degrees of abduction in the costoclavicular space. The 130 degrees hyperabduction maneuver appeared to be the most discriminating postural maneuver. Seven patients assessed with MR imaging did not have any arterial stenosis on MR images, whereas an appreciable degree of arterial stenosis was shown with ultrasonography.
Arterial compression inside the thoracic outlet can be detected and quantified with B-mode imaging in association with PDU.
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ABSTRACT: The aim of this study was to determine changes in axillary artery diameter and peak systolic velocity in asymptomatic individuals during upper limb positioning commonly used to assess vascular pathology in athletes. Repeated measures observational study. Physiology laboratory. Subjective and objective screening excluded individuals with past, or present, conditions related to neurovascular compression syndromes. Thirty-one subjects (21 females, 10 males; mean age: 25+/-4 years) were included in the final analysis. Sonographically determined axillary artery diameter and peak systolic velocity, as well as symptom production, were recorded for a series of 12 randomised arm positions, incorporating varying degrees of abduction, external rotation, and horizontal flexion/extension. The majority of arm positions revealed no change in artery diameter and peak systolic velocity. However, at the extreme of abduction, and arm positions incorporating 120 degrees abduction, significant (p<0.0005) reductions in axillary artery diameter were noted. All mean results masked wide heterogeneity: 13% demonstrating a greater than 50% reduction in diameter, 10%, a doubling of peak systolic velocity, and 42%, reporting symptoms. The number of individual clinically "positive" responses questions the specificity of individual diagnostic tests, such as the hyperabduction manoeuvre, and highlights the need to interpret test results in conjunction with the subjective assessment and other physical findings from the objective assessment.Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine 08/2008; 9(3):126-35. DOI:10.1016/j.ptsp.2008.06.009 · 1.37 Impact Factor
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ABSTRACT: Thoracic outlet syndrome is a clinical entity characterized by compression of the neurovascular bundle, and may be associated with additional findings such as venous thrombosis, arterial stenosis, or neurologic symptoms. The goal of imaging is to localize the site of compression, the compressing structure, and the compressed organ or vessel, while excluding common mimics. A literature review is provided of current indications for diagnostic imaging, with discussion of potential limitations and benefits of the respective modalities. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. In this document, we provided guidelines for use of various imaging modalities for assessment of thoracic outlet syndrome. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.Journal of the American College of Radiology: JACR 03/2015; 12(5). DOI:10.1016/j.jacr.2015.01.016 · 2.28 Impact Factor
- Revue du Rhumatisme 04/2007; 74(4):333-338. DOI:10.1016/j.rhum.2007.01.002