Sonographic Imaging of Vascular Thoracic Outlet Syndrome

ABSTRACT Thoracic outlet syndrome (TOS) is a clinical condition where patients experience a range of symptoms resulting from compression of neurovascular structures within the thoracic outlet. TOS can be divided into two main subtypes: the more common neurogenic TOS (NTOS) and less common vascular TOS (VTOS). VTOS includes venous and arterial subsets and can result from compression of the subclavian, and less commonly the axillary vessels within three distinct spaces of the thoracic outlet. These include from medial to lateral; the interscalene, costo‐clavicular, and the retro‐pectoral spaces. Dynamic ultrasound assessment of the subclavian and axillary vessels as they course through the thoracic outlet, allows for vascular compression and subsequent altered blood flow to be diagnosed. To sonographically image the vascular structures of the thoracic outlet at each of the spaces, a deep understanding of the sonographic anatomy and imaging technique, including dynamic assessment using provocative maneuvers to reproduce symptoms, are required to diagnose VTOS and guide timely patient management.