{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:46:14Z","timestamp":1790109974918,"version":"4.0.1"},"reference-count":47,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,1]],"date-time":"2024-09-01T00:00:00Z","timestamp":1725148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Thoracic outlet syndrome (TOS) is a group of symptoms caused by the compression of neurovascular structures of the superior thoracic outlet. The knowledge of its clinical presentation with specific symptoms, as well as proper imaging examinations, ranging from plain radiographs to ultrasound, computed tomography and magnetic resonance imaging, may help achieve a precise diagnosis. Once TOS is recognized, proper treatment may comprise a conservative or a surgical approach.<\/jats:p>","DOI":"10.3390\/tomography10090103","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T02:25:49Z","timestamp":1725416749000},"page":"1365-1378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Diagnostic and Therapeutic Approach to Thoracic Outlet Syndrome"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5151-0866","authenticated-orcid":false,"given":"Stefania","family":"Rizzo","sequence":"first","affiliation":[{"name":"Imaging Institute of Italian Switzerland (IIMSI), Ente Ospedaliero Cantonale, via Tesserete 46, 6900 Lugano, Switzerland"},{"name":"Facolt\u00e0 di Scienze Biomediche, Universit\u00e0 della Svizzera Italiana, via G.Buffi 13, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cammillo","family":"Talei Franzesi","sequence":"additional","affiliation":[{"name":"Division of Radiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6314-8518","authenticated-orcid":false,"given":"Andrea","family":"Cara","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico Mario","family":"Cassina","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Libretti","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Pirondini","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Raveglia","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Tuoro","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Vaquer","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Degiovanni","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica Michela","family":"Cavalli","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Marchesi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Froio","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"},{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5945-1576","authenticated-orcid":false,"given":"Francesco","family":"Petrella","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e545","DOI":"10.1016\/j.jse.2022.06.026","article-title":"Thoracic outlet syndrome: A review","volume":"31","author":"Panther","year":"2022","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.jvs.2016.04.039","article-title":"Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome","volume":"64","author":"Illig","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.thorsurg.2020.09.002","article-title":"Imaging Assessment of Thoracic Outlet Syndrome","volume":"31","author":"Khalilzadeh","year":"2021","journal-title":"Thorac. Surg. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/00127893-200109000-00008","article-title":"10 most commonly asked questions about thoracic outlet syndrome","volume":"7","author":"Wilbourn","year":"2001","journal-title":"Neurologist"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e30360","DOI":"10.1097\/MD.0000000000030360","article-title":"Comparison of duplex ultrasound and hemodynamic assessment with computed tomography angiography in patients with arterial thoracic outlet syndrome","volume":"101","author":"Altuwaijri","year":"2022","journal-title":"Medicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1080\/01616412.2023.2177809","article-title":"The role of computed tomography and magnetic resonance imaging in surgical planning for thoracic outlet syndrome: The experience of a single third level reference center for peripheral nerve surgery","volume":"45","author":"Turrini","year":"2023","journal-title":"Neurol. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3400\/avd.oa.12.00081","article-title":"Surgical management of vascular thoracic outlet syndrome: A teaching hospital experience","volume":"6","author":"Aljabri","year":"2013","journal-title":"Ann. Vasc. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1515\/jom-2021-0276","article-title":"Thoracic outlet syndrome: A review for the primary care provider","volume":"122","author":"Cavanna","year":"2022","journal-title":"J. Osteopath. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Levine, N.A., and Rigby, B.R. (2018). Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations. Healthcare, 6.","DOI":"10.3390\/healthcare6020068"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Povlsen, S., and Povlsen, B. (2018). Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions. Diagnostics, 8.","DOI":"10.3390\/diagnostics8010021"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s12178-020-09643-x","article-title":"Thoracic Outlet Syndrome in the Overhead Athlete: Diagnosis and Treatment Recommendations","volume":"13","author":"Ohman","year":"2020","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.jhsg.2022.07.004","article-title":"Modern Treatment of Neurogenic Thoracic Outlet Syndrome: Pathoanatomy, Diagnosis, and Arthroscopic Surgical Technique","volume":"5","author":"Ahmed","year":"2023","journal-title":"J. Hand Surg. Glob. Online."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.21037\/qims.2020.02.06","article-title":"MRI in the assessment of adipose tissues and muscle composition: How to use it","volume":"10","author":"Huber","year":"2020","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"20210054","DOI":"10.1259\/bjr.20210054","article-title":"Quantitative diffusion and perfusion MRI in the evaluation of endometrial cancer: Validation with histopathological parameters","volume":"94","author":"Satta","year":"2021","journal-title":"Br. J. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"572","DOI":"10.55730\/1300-0144.5824","article-title":"Cross-cultural adaptation of the Thoracic Outlet Syndrome Index for Turkish-speaking patients with thoracic outlet syndrome","volume":"54","author":"Basat","year":"2024","journal-title":"Turk. J. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Expert Panels on Vascular Imaging, Thoracic Imaging, and Neurological Imaging, Zurkiya, O., Ganguli, S., Kalva, S.P., Chung, J.H., Shah, L.M., Majdalany, B.S., Bykowski, J., Carter, B.W., and Chandra, A. (2020). ACR Appropriateness Criteria\u00ae Thoracic Outlet Syndrome. J. Am. Coll. Radiol., 17, S323\u2013S334.","DOI":"10.1016\/j.jacr.2020.01.029"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"222","DOI":"10.5435\/JAAOS-D-13-00215","article-title":"Thoracic Outlet Syndrome","volume":"23","author":"Kuhn","year":"2015","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Martelli, E., Enea, I., Zamboni, M., Federici, M., Bracale, U.M., Sangiorgi, G., Martelli, A.R., Messina, T., and Settembrini, A.M. (2023). Focus on the Most Common Paucisymptomatic Vasculopathic Population, from Diagnosis to Secondary Prevention of Complications. Diagnostics, 13.","DOI":"10.20944\/preprints202305.0209.v1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S1297-319X(01)00298-6","article-title":"Diagnosing thoracic outlet syndrome: Contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients","volume":"68","author":"Gillard","year":"2001","journal-title":"Jt. Bone Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.math.2007.07.010","article-title":"Sonographic evaluation of the subclavian artery during thoracic outlet syndrome shoulder manoeuvres","volume":"14","author":"Stapleton","year":"2009","journal-title":"Man. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ejvsvf.2024.02.003","article-title":"Validity of Ultrasound for the Diagnosis of Arterial Thoracic Outlet Syndrome","volume":"61","author":"Stegemann","year":"2024","journal-title":"EJVES Vasc. Forum"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.diii.2014.01.020","article-title":"Ultrasonography of the brachial plexus, normal appearance and practical applications","volume":"95","author":"Lapegue","year":"2014","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1016\/j.ultrasmedbio.2016.06.005","article-title":"Ultrasonographic Identification of Fibromuscular Bands Associated with Neurogenic Thoracic Outlet Syndrome: The \u201cWedge-Sickle\u201d Sign","volume":"42","author":"Csillik","year":"2016","journal-title":"Ultrasound Med. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1102\/1470-7330.2006.0001","article-title":"Contrast enhanced ultrasound of breast cancer","volume":"6","author":"Cassano","year":"2006","journal-title":"Cancer Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.rcl.2022.04.006","article-title":"Practical Contrast Enhanced Liver Ultrasound","volume":"60","author":"Squires","year":"2022","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.jmir.2019.08.010","article-title":"The Role of Contrast-Enhanced Ultrasound in Managing Vascular Pathologies","volume":"50","author":"Thakrar","year":"2019","journal-title":"J. Med. Imaging Radiat. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00256-010-0897-1","article-title":"Botulinum toxin injection in neurogenic thoracic outlet syndrome: Results and experience using a ultrasound-guided approach","volume":"39","author":"Torriani","year":"2010","journal-title":"Skeletal Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.jvs.2016.05.047","article-title":"Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome: Executive summary","volume":"64","author":"Illig","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1148\/rg.2016150221","article-title":"Imaging of the Patient with Thoracic Outlet Syndrome","volume":"36","author":"Raptis","year":"2016","journal-title":"Radiographics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.2214\/ajr.174.6.1741667","article-title":"Helical CT angiography of thoracic outlet syndrome: Functional anatomy","volume":"174","author":"Remy","year":"2000","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1213\/ANE.0000000000001327","article-title":"The Influence of Arm Positioning on Ultrasonic Visualization of the Subclavian Vein: An Anatomical Ultrasound Study in Healthy Volunteers","volume":"123","author":"Sadek","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/mus.23235","article-title":"The thoracic outlet syndromes","volume":"45","author":"Ferrante","year":"2012","journal-title":"Muscle Nerve"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1227\/01.NEU.0000137889.51323.0D","article-title":"Gilliatt-Sumner hand revisited: A 25-year experience","volume":"55","author":"Tender","year":"2004","journal-title":"Neurosurgery"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1093\/qjmed\/hcy122","article-title":"The Gilliatt-Sumner hand: A diagnostic clue of neurogenic thoracic outlet syndrome","volume":"111","author":"Matsubara","year":"2018","journal-title":"QJM"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1007\/s00330-013-3060-2","article-title":"Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus","volume":"24","author":"Baumer","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jns.2019.07.024","article-title":"Clinical, electrodiagnostic and imaging features of true neurogenic thoracic outlet syndrome: Experience at a tertiary referral center","volume":"404","author":"Kim","year":"2019","journal-title":"J. Neurol. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0749-0712(03)00081-7","article-title":"Conservative treatment for thoracic outlet syndrome","volume":"20","author":"Crosby","year":"2004","journal-title":"Hand Clin."},{"key":"ref_38","first-page":"55","article-title":"Conservative treatment of thoracic outlet syndrome","volume":"43","author":"Vanti","year":"2007","journal-title":"Eura Medicophys"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/j.avsg.2007.07.017","article-title":"Management of effort thrombosis of the subclavian vein: Today\u2019s treatment","volume":"21","author":"Doyle","year":"2007","journal-title":"Ann. Vasc. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/00000658-196603000-00005","article-title":"Transaxillary approach for first rib resection to relieve thoracic outlet syndrome","volume":"163","author":"Roos","year":"1966","journal-title":"Ann. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Illig, K., Thompson, R., Freischlag, J., Donahue, D., Jordan, S., and Edgelow, P. (2013). Surgical Techniques: Operative Decompression Using the Transaxillary Approach for VTOS. Thoracic Outlet Syndrome, Springer. Chapter 61.","DOI":"10.1007\/978-1-4471-4366-6"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3171\/jns.1968.28.1.0081","article-title":"Relief of costoclavicular syndrome by infraclavicular removal of fi rst rib","volume":"28","author":"Gol","year":"1968","journal-title":"J. Neurosurg."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Illig, K., Thompson, R., Freischlag, J., Donahue, D., Jordan, S., and Edgelow, P. (2013). Surgical Techniques: Operative Decompression Using the Paraclavicular Approach for VTOS. Thoracic Outlet Syndrome, Springer. Chapter 63.","DOI":"10.1007\/978-1-4471-4366-6"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0003-4975(96)01023-5","article-title":"Transmanubrial osteomuscular sparing approach for apical chest tumors","volume":"63","author":"Grunenwald","year":"1997","journal-title":"Ann. Thorac. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/S0741-5214(98)70337-4","article-title":"A new surgical approach to the innominateand subclavian vein","volume":"27","author":"Molina","year":"1998","journal-title":"J. Vasc. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"ezae019","DOI":"10.1093\/ejcts\/ezae019","article-title":"Modified transmanubrial approach for complicated type 1 cervical rib resection requiring subclavian artery reconstruction","volume":"65","author":"Petrella","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"E632","DOI":"10.1097\/BRS.0000000000003859","article-title":"Efficacy of Supraclavicular Scalenotomy Followed by External Neurolysis without Rib Resection for Post-traumatic Neurogenic Thoracic Outlet Syndrome","volume":"46","author":"Yoshizumi","year":"2021","journal-title":"Spine"}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/9\/103\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:46:39Z","timestamp":1760111199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/9\/103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,1]]},"references-count":47,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["tomography10090103"],"URL":"https:\/\/doi.org\/10.3390\/tomography10090103","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,1]]}}}