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Thoracic Outlet: Assessment with MR Imaging in Asymptomatic and Symptomatic Populations¹

¹ From the Departments of Osteoarticular Radiology (X.D., E.B., C.P., A.C.) and Rheumatology (B.D.), Hôpital Roger Salengro, Centre Hospitalier Regional Universitaire de Lille, Boulevard du Pr. J. Leclercq, 59037 Lille, France; Anatomy Laboratory, Faculty of Medicine, Université de Lille 2, France (X.D.); and Department of Internal Medicine, Hôpital Claude Huriez, Lille, France (E.H.). Received January 2, 2002; revision requested February 28; final revision received August 19; accepted August 27. Address correspondence to X.D. (e-mail: xdemondion@chru-lille.fr).

View larger version (154K): [in a new window]   Figure 1. Sagittal T1-weighted MR image (544/14) of the interscalene triangle obtained in a 32-year-old male volunteer after hyperabduction of the arm shows the clavicle (1), the subclavian artery (2), the maximum thickness of the anterior scalene muscle (3), the middle and posterior scalene muscles (4), and the interscalene angle ( between the two white lines).

View larger version (124K): [in a new window]   Figure 2a. Sagittal T1-weighted MR images (544/14) of the costoclavicular space in a 41-year-old female volunteer obtained (a) with the arm alongside the body and (b) after hyperabduction of the arm show the clavicle (1), the subclavian artery (2), the subclavian vein (3), the angle ( in a) between the axis of the first rib and horizontal, the maximum thickness of the subclavius muscle (line at 4), and the minimum costoclavicular distance (line between 1 and 5).

View larger version (127K): [in a new window]   Figure 2b. Sagittal T1-weighted MR images (544/14) of the costoclavicular space in a 41-year-old female volunteer obtained (a) with the arm alongside the body and (b) after hyperabduction of the arm show the clavicle (1), the subclavian artery (2), the subclavian vein (3), the angle ( in a) between the axis of the first rib and horizontal, the maximum thickness of the subclavius muscle (line at 4), and the minimum costoclavicular distance (line between 1 and 5).

View larger version (163K): [in a new window]   Figure 3a. Sagittal T1-weighted MR images (544/14) of the retropectoralis minor space in a 37-year-old female volunteer obtained (a) with the arm alongside the body and (b) after hyperabduction of the arm show the pectoralis minor muscle (1), the coracoid process (2), and the distance (line at 3) between the posterior border of the pectoralis minor muscle and the anterior chest wall at the passage of the axillary vessels.

View larger version (155K): [in a new window]   Figure 3b. Sagittal T1-weighted MR images (544/14) of the retropectoralis minor space in a 37-year-old female volunteer obtained (a) with the arm alongside the body and (b) after hyperabduction of the arm show the pectoralis minor muscle (1), the coracoid process (2), and the distance (line at 3) between the posterior border of the pectoralis minor muscle and the anterior chest wall at the passage of the axillary vessels.

View larger version (151K): [in a new window]   Figure 4a. (a) Sagittal and (b) coronal T1-weighted MR images (544/14) of the interscalene triangle obtained after hyperabduction of the arm in a 42-year-old female patient who had neuroarterial symptoms in the upper arm. Note that the subclavian artery (arrow) is compressed and lifted up by a tiny fibrous structure (arrowhead); this finding was confirmed at surgery.

View larger version (164K): [in a new window]   Figure 4b. (a) Sagittal and (b) coronal T1-weighted MR images (544/14) of the interscalene triangle obtained after hyperabduction of the arm in a 42-year-old female patient who had neuroarterial symptoms in the upper arm. Note that the subclavian artery (arrow) is compressed and lifted up by a tiny fibrous structure (arrowhead); this finding was confirmed at surgery.

View larger version (115K): [in a new window]   Figure 5a. Sagittal T1-weighted MR images (544/14) of the costoclavicular space in 35-year-old female patient with arterial symptoms obtained (a) with arms alongside the body and (b) after hyperabduction of the arms. Hyperabduction results in compression of the subclavian artery (arrow).

View larger version (140K): [in a new window]   Figure 5b. Sagittal T1-weighted MR images (544/14) of the costoclavicular space in 35-year-old female patient with arterial symptoms obtained (a) with arms alongside the body and (b) after hyperabduction of the arms. Hyperabduction results in compression of the subclavian artery (arrow).

View larger version (166K): [in a new window]   Figure 6a. Sagittal T1-weighted MR images (544/14) of (a) the costoclavicular space and (b) the retropectoralis minor space obtained after hyperabduction of the arms in a 33-year-old male patient with venous symptoms. Note the collateral venous pathways (arrows), a consequence of subclavian vein thrombosis.

View larger version (190K): [in a new window]   Figure 6b. Sagittal T1-weighted MR images (544/14) of (a) the costoclavicular space and (b) the retropectoralis minor space obtained after hyperabduction of the arms in a 33-year-old male patient with venous symptoms. Note the collateral venous pathways (arrows), a consequence of subclavian vein thrombosis.

View larger version (112K): [in a new window]   Figure 7a. Sagittal T1-weighted MR images (544/14) of the costoclavicular space in a 46-year-old female patient with neurologic symptoms obtained (a) with arms alongside the body and (b) after hyperabduction of the arms. Note the narrowness of the costoclavicular space, the contact between the clavicle and the cords of the brachial plexus (arrow), and the disappearance of the surrounding fat after arm hyperabduction (compare with Fig 2b).

View larger version (124K): [in a new window]   Figure 7b. Sagittal T1-weighted MR images (544/14) of the costoclavicular space in a 46-year-old female patient with neurologic symptoms obtained (a) with arms alongside the body and (b) after hyperabduction of the arms. Note the narrowness of the costoclavicular space, the contact between the clavicle and the cords of the brachial plexus (arrow), and the disappearance of the surrounding fat after arm hyperabduction (compare with Fig 2b).