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Unilateral Arm Swelling

Unilateral Arm Swelling. Tim Kubal. Venogram. Provocative Venogram. Thoracic Outlet Syndrome. Compression of neurovascular structures as they pass through the thoracic outlet. NTOS, ATOS, VTOS (Paget-Schroetter Syndrome)

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Unilateral Arm Swelling

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  1. Unilateral Arm Swelling • Tim Kubal

  2. Venogram

  3. Provocative Venogram

  4. Thoracic Outlet Syndrome • Compression of neurovascular structures as they pass through the thoracic outlet. • NTOS, ATOS, VTOS (Paget-Schroetter Syndrome) • Whiplash, Repetitive activity, rib anomaly, prior clavicular fx, fibrosis.

  5. Anatomy

  6. NTOS • Most common with the majority of these cases being related to trauma and virtually impossible to diagnose objectively • Paresthesias, pain • Tx conservatively in majority of cases unless demonstrable anatomical abnormality then consider surgery

  7. VTOS • Majority of cases related to strenuous or repetitive overhead activity. • Acute or subacute swelling, heaviness, pain, venous distention with visible collaterals. • Acute: Thrombolytics, stenting/venoplasty, surgical decompression, anticoagulation. • Subacute: Conservative vs. Surgery

  8. ATOS • Least common • Subclavian Artery Compression • Typically secondary to demonstrable rib abnormality • Pain, Paresthesias, Cyanosis, Embolism, Negative Pulses, Slow capillary refill

  9. How do i work this up? • Provocative testing • Dopplers (Acutely r/o thrombosis) • C-Spine films, shoulder films • CT chest

  10. Management • VTOS: Usually requires urgent thrombolysis, anticoag, surgical decompressions • ATOS: surgical decompression and restoration of arterial blood flow • NTOS: PT, surgical decompression.

  11. Surgery • Rib, muscle resection • Less stuff • More space

  12. What else could it be? • Brachial plexus injury • Carpal Tunnel • CRPS • Malignancy • C-Spine or shoulder MSK • Nothing

  13. TOS • JR Richard (CVA) • David Cone (Arterial aneurysm) • Hanson

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