Recurrent Arm swelling: do not forget Thoracic outlet syndrome

Key words: Thoracic outlet syndrome, Hyposphygmia, Wright test, Arm swelling

Thoracic outlet syndrome is caused by the compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or soft-tissue abnormalities. Thoracic outlet syndrome commonly affects young adults but can be observed in the paediatric age group, especially in older children. It is a neurovascular compression syndrome with very variable symptoms that can be neurological or vascular. Diagnosis is based on clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging studies like MRI and MR angiography are performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome by neurogenic, arterial, venous or mixed causes. The paper reports two paediatric cases of thoracic outlet syndrome presenting with recurrent episodes of arm swelling and underlines the importance of performing some diagnostic maneuvers in these cases.