RESUMO
Resumo A forma arterial da síndrome do desfiladeiro torácico é rara e está associada a uma anomalia anatômica, geralmente uma costela cervical. Suas manifestações são muito variadas. Este artigo tem como proposta relatar dois casos de apresentações clínicas distintas: microembolização e aneurisma. Em ambos, uma costela cervical estava presente. O diagnóstico foi realizado através da história, do exame físico, das manobras posturais e das radiografias. A angiotomografia computadorizada proporcionou o detalhe anatômico necessário para o planejamento operatório. O tratamento cirúrgico foi realizado pela abordagem supraclavicular, com sucesso em ambos casos.
Abstract The arterial form of thoracic outlet syndrome is rare and is associated with anatomic anomalies, generally a cervical rib. It has a varied range of manifestations. The aim of this article is to describe two cases with different clinical presentations: microembolization and aneurysm. A cervical rib was present in both cases. Diagnosis was made on the basis of history, physical examination, postural maneuvers, and X-rays. Computed tomography angiography provided the anatomic detail necessary to plan surgery. Surgical treatment was performed via supraclavicular access, successfully, in both cases.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Síndrome do Desfiladeiro Torácico/cirurgia , Costela Cervical/fisiopatologia , Artéria Subclávia , Síndrome do Desfiladeiro Torácico/diagnóstico , Descompressão Cirúrgica , Angiografia por Tomografia ComputadorizadaRESUMO
The constancy of the number of cervical vertebrae in mammals is probably the result of selection against associated variations. A survey among patients with and without cervical ribs showed an association between miscarriage and the presence of cervical ribs. This supports the hypothesized selection against variations in cervical vertebral number.
Assuntos
Aborto Espontâneo/epidemiologia , Costela Cervical/fisiopatologia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Costela Cervical/diagnóstico por imagem , Costela Cervical/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Gravidez , Prevalência , Síndrome do Desfiladeiro Torácico/complicações , Síndrome do Desfiladeiro Torácico/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Cervical rib can often be symptomatic causing neurogenic thoracic outlet syndrome (nTOS). Surgical treatment involves rib resection through a supraclavicular, transaxillary or combined approach. We review outcomes of different approaches and describe our technique of transaxillary resection through a video. METHODS: A single-center retrospective review of perioperative and short-term outcomes in subjects undergoing cervical rib resection for nTOS between 1994 and 2013 was performed. RESULTS: Of the 75 operations performed for nTOS, 40% (30 procedures in 29 patients) required resection of cervical ribs. The first and cervical ribs were removed in 24 operations, whereas only the cervical rib was resected in 6. Scalenectomy was performed in all patients. Thirteen (43%) procedures were performed with a supraclavicular-only (SC group) approach, 9 (30%) with a transaxillary-only (TA group) approach, and 8 (27%) with a combined approach (TA + SC group). Incidence of persistent nTOS symptoms occurred in 3 (23%) of SC patients, 1 (13%) TA patient, and 2 (25%) TA + SC patients (P > 0.05). Recurrence of symptoms was noted in one patient (8%) in the SC group at 1-year follow-up. No patient required operative reintervention. CONCLUSIONS: Resection of cervical ribs and/or first ribs in the treatment of nTOS can be safely performed through SC, TA, or a combined approach. In young patients, a TA incision should be considered to avoid a neck incision, with outcomes similar to alternate approaches.
Assuntos
Costela Cervical/cirurgia , Osteotomia/métodos , Síndrome do Desfiladeiro Torácico/cirurgia , Adolescente , Adulto , Idoso , Costela Cervical/diagnóstico por imagem , Costela Cervical/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Osteotomia/efeitos adversos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Cervical rib usually causes neurological symptoms in the upper limb but stroke as an initial presentation is very uncommon. Recurrent supratentorial and infratentorial stroke in a single patient is very rare. Cervical rib can lead to anterograde or retrograde thromboembolic phenomenon leading to ischemic stroke. CASE REPORT: A 14-year-old girl presented with a history of sudden onset of loss of consciousness and left hemiparesis of 2 days duration. She had a similar episode 2 years ago, from which she had recovered to a large extent with minimal residual left hemiparesis. On examination, she was unconscious and localizing to pain on the right side. Radial pulse was absent on the right side. Magnetic resonance imaging of the brain revealed a right fronto-temporo-parietal old infarct with a new subacute infarct involving right cerebellar hemisphere and brainstem. X-ray of the chest showed a right-sided cervical rib. Computed tomographic angiography of the neck vessels revealed stenosis of subclavian artery at the site of the cervical rib with poststenosis dilatation. Patient was managed with anticoagulant and antiplatelet therapy initially and excision of the cervical rib was performed as a definitive procedure. She responded well to the treatment and at 6 months of follow-up, the strength on the left side had improved substantially. She was capable of doing her daily activities independently with little imbalance. CONCLUSIONS: The reported patient is the first in the literature who suffered recurrent supratentorial and infratentorial stroke as a complication of cervical rib. We stress the need for early diagnosis of this easily treatable cause of stroke in the young.
Assuntos
Síndrome da Costela Cervical/complicações , Costela Cervical/fisiopatologia , Acidente Vascular Cerebral/etiologia , Síndrome do Roubo Subclávio/complicações , Adolescente , Costela Cervical/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , RecidivaRESUMO
Congenital brachial plexus palsy (CBPP) usually occurs secondarily to intrapartum trauma, but this is not always the case. Cervical ribs have previously been reported to increase the risk of CBPP in association with birth trauma. We report the cases of two children (one female, one male) with congenital lower brachial plexus palsy in whom the presence of non-ossified cervical ribs was the only identified risk factor. In the female child magnetic resonance imaging (MRI) of the brain, spinal cord, and brachial plexus revealed no abnormality except for the presence of bilateral cervical ribs at the level of the seventh cervical (C7) vertebra. Chest radiography was normal, which suggested that the cervical ribs identified on the MRI were fibrous bands or cartilaginous ribs rather than ossified ribs. In the male child, MRI of the spine and brachial plexus was normal but he was noted to have bilateral cervical ribs at C7. These were not identifiable on chest radiography and, therefore, are likely to reflect fibrous bands or cartilaginous ribs.
Assuntos
Neuropatias do Plexo Braquial/congênito , Síndrome da Costela Cervical/congênito , Costela Cervical/anormalidades , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/fisiopatologia , Costela Cervical/fisiopatologia , Síndrome da Costela Cervical/diagnóstico , Síndrome da Costela Cervical/fisiopatologia , Pré-Escolar , Eletromiografia , Feminino , Seguimentos , Antebraço/inervação , Mãos/inervação , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Nervo Mediano/fisiopatologia , Debilidade Muscular/congênito , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Atrofia Muscular/congênito , Atrofia Muscular/diagnóstico , Atrofia Muscular/fisiopatologia , Condução Nervosa/fisiologia , Exame Neurológico , Nervo Ulnar/fisiopatologiaRESUMO
Analysed herein are the findings of examination and outcomes of surgical management of fifty-eight patients (25 men and 33 women) presenting with Falconer-Weddel's costoclavicular syndrome in which the subclavian artery and vein and the brachial plexus at the thoracic outlet appear to be compressed. Of the 58 patients,five subjects were found to have a rudimentary cervical rib and three more (5.3%) patients had trophic disorders on their digits fingers: dystrophy of the nail plates, their fragility, periodically opening trophic ulcers at the digital tips and one patient presented with gangrene of the inguinal phalanx of the middle finger. Three patients had hyperemia of the face. A further four patients had roughening, hyperkeratosis of the skin of the hands, cracks. The presence of the supernumerary ribs was determined roentgenologically. Haemodynamics was studied using Doppler ultrasonography making it possible to reveal disordered blood flow in the upper-limb arteries in the physiological position assumed, in the Adson test as well as with Raynaud syndrome, which was observed in 39 patients. The function of the nerves was studied using electroneuromyography (ENMG). All patients were operated on under endotracheal anaesthesia. Decompression-medical operations were carried outperformed in all 58 patients, with the following four types of interventions being performed: transaxillary resection of the first rib combined with sympathectomy carried out in 23 patients, resection of the first rib without sympathectomy in eighteen patients, resection of the first rib via a surpraclavicular approach in four patients, scalenotomy and selective cervicothoracic sympathectomy in 13 patients.