Eur J Cardiothorac Surg 2006;30:674
© 2006 Elsevier Science NL
Images in cardio-thoracic surgery |
Transient thoracic duct obstruction in a patient with thoracic outlet syndrome
Giulio Mellonia,*,
Michele Giovanardia,
Angela De Gasparib,
Piero Zanninia
a Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
b Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
Received 12 April 2006;
received in revised form 5 June 2006;
accepted 26 June 2006.
* Corresponding author. Address: Unità Operativa di Chirurgia Toracica, Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy. Tel.: +39 0226437139; fax: +39 0226437147. (Email: giulio.melloni{at}hsr.it).
Key Words: Thoracic outlet syndrome • Thoracic duct • MRI
A 51-year-old woman with a thoracic outlet syndrome and vascular compression (Fig. 1
) developed a transitory cervical and mediastinal lymphoedema (Fig. 2
) after sleeping for a night with her arms raised and abducted. We hypothesize that this unusual complication was caused by a temporary obstruction of the thoracic duct at its junction with the venous system due to this sleeping position.
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Fig. 1. A magnetic resonance imaging (MRI) angiography performed with the patient with both arms raised above the head demonstrated a thoracic outlet syndrome with segmental occlusion (arrow) of the left subclavian artery (A) and vein (B).
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Fig. 2. A MRI revealed a lymphoedema of the neck and mediastinum (arrow) (A, STIR image) that spontaneously disappeared in a few days. A MRI performed after a week was completely normal (B, T2-weighted image). The patient was conservatively treated. A physiotherapy program was started and she was encouraged to sleep with arms by the side. At the time of writing, 1 year after the event, the patient had experienced no further episode of cervical oedema.
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