Thoracic Outlet Syndrome

Soft tissue cervical injuries are among the most common posttrauma problems faced by general practitioners, orthopedists and neurosurgeons. The development of the thoracic outlet syndrome (TOS) following such injuries is more frequent than is generally recognized. Conservative treatment with physiotherapy, muscle relaxants, anti-inflammatory drugs and percutaneous electrostimulation usually proves effective in relieving TOS. In this series of 1,958 soft tissue cervical injuries, 459 patients (23 percent) were diagnosed as having TOS. Of these patients, 185 (41 percent) failed to respond to all conservative measures and consequently surgical operation in the form of a supraclavicular neurovascular decompression became necessary to relieve not only the symptoms of the neck-shoulder-arm syndrome but also to relieve a frequently unrecognized (72 percent) vertebrobasilar artery syndrome. The latter is most definitely an integral part of TOS. The most common misdiagnoses were cervical disc syndrome (42 percent) and cervical strain (42 percent). A long-term follow-up (average of seven years) of 90 patients showed that the results were judged good in 75 percent, fair in 11 percent and poor in 14 percent.     

Thoracic lymphatic disorders

Thoracic complications of lymphatic disorders can culminate in respiratory failure and death and should be considered in any patient with a lymphatic disease and clinical or radiographic evidence of chest disease. Congenital lymphatic disorders are being increasingly recognized in the adult population. The spectrum of thoracic manifestations of lymphatic disorders ranges from incidental radiographic findings to diffuse lymphatic disease with respiratory failure. This article serves to review some recent advances that allow improved diagnosis and management of thoracic lymphatic disorders. Herein, we describe their anatomical and physiologic effects, the time course of their progression, and the therapies that are currently available. The management of malignant (cancerous) lymphatic disorders of the thorax is beyond the scope of this paper.