Thoracic Outlet Syndrome | Figure 1

Thoracic Outlet Syndrome

25 yr old female presented with a subclavian DVT. Upon getting a thrombectomy, it was found that the patient had venous thoracic outlet syndrome. A month later the patient underwent a first rib resection. About a month after surgery the patient began to feel symptoms in the arm again similar to the initial symptoms of the blood clot.

Symptoms: discoloring of arm, quick fatigue, aching, minor swelling.

Patient underwent another venogram which showed narrowing to the axillary vein, vein was dilated and a week later patient began to feel the same symptoms again. Patient is on blood thinners.

What is the recommended course of treatment? Surgical intervention? Stent? How long does the patient need to stay on anticoagulants?

Case References

1. Rash in Child

3 year old, rash began about 3-4 months again. Lesions are isolated to lateral trunk and bicep of ipsilateral arm. Seems painless to light touch but painful when attempting to expel lesions. Any idea of a diagnosis or treatment plan. #Molluscum-contagiosum?](https://app.figure1.com/case-detail/0117a6ce-4413-46c4-8e05-e5d4a289e980)

2. Fatigue and Orthostatic Hypotension

I had a 34 year old female come in today after complaining of constant fatigue and orthostatic hypotension. The patient reports lying down with her baby and feeling Tired but nothing out of the ordinary. After about 2 hours of lying down, she got up and began to feel strange. Pt reports her Heart pounding, feeling lightheaded, shaky, nauseous, weak and thought it was possibly caused by low blood sugar. She used a friends blood glucose monitor and her blood sugar was 85. She checked her blood pressure and it was 109/93 with a HR: 118. (Pt baseline blood pressure is 95/70). She reports eating some fruit snacks and a chicken nugget and drank some water, but still didn’t feel well. She then laid down again for about 25 minutes and while lying down took her blood pressure once more. This time it was 92/50 with HR: 90 (an hour after high bp was taken). At this point pt reports feeling tired but heart racing and lightheadedness subsided. She stood back up and after 3 minutes of standing, her blood pressure went to 111/78 with HR: 94. Her symptoms were gone and her energy was back to normal. Is this considered a typical POTS scenario? She did have blood work done about a month ago with the only off level being her see rate:34 and negative ANA with elevated SSA and Anticardiolipin IgM. This is the second patient I’ve seen within the past 2 months with these symptoms and blood test results. Both females in their early 30’s with no significant past medical hx other than fatigue. Sending her to Rheumatologist next. Any idea what is causing it?](https://app.figure1.com/case-detail/12eb95e3-3a9c-4a70-bb78-d06a1a2c14f0)

3. Varicose and Spider Veins

varicose veins, spider veins. No symptoms. What to do?](https://app.figure1.com/case-detail/21f282f4-a113-4c31-89d6-91062b5e6654)

4. May-Thurner Syndrome

May-Thurner is correct. A self expandable stent was placed in the left common iliac vein and venogram demonstrates patency without retrograde flow. CT abdomen and pelvis demonstrates patent left internal iliac vein with self expanding stent in place. 1 year later patient had recurrence of symptoms and CT showed mural thrombus with in-stent stenosis (image 3). Initial venogram on image 4 demonstrated in-stent stenosis with mural thickening. Angioplasty was performed and post procedure venogram film is shown on image 5.](https://app.figure1.com/case-detail/2e903e6f-3fae-4a13-9eeb-1a9b9d542f26)

5. Chest Pain Presentation

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

6. Pruritus and Vesicular Eruptions

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

7. Infant Skin Lesions

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

8. Cardiac Collapse in Teenager

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)