title: Preoperative Duplex Scanning is a Helpful Diagnostic Tool in Neurogenic Thoracic Outlet Syndrome.
abstract: OBJECTIVE
  To evaluate the diagnostic role of venous and arterial duplex scanning in neurogenic thoracic outlet syndrome (NTOS).
  
  
  METHODS
  Retrospective review of patients who underwent duplex ultrasonography prior to first rib resection and scalenectomy (FRRS) for NTOS from 2005 to 2013. Abnormal scans included ipsilateral compression (IC) with abduction of the symptomatic extremity (>50% change in subclavian vessel flow), contralateral (asymptomatic side) compression (CC) or bilateral compression (BC).
  
  
  RESULTS
  A total of 143 patients (76% female, average age 34, range 13-59) underwent bilateral preoperative duplex scanning. Ipsilateral compression was seen in 44 (31%), CC in 12 (8%), and BC in 14 (10%). Seventy-three (51%) patients demonstrated no compression. Patients with IC more often experienced intraoperative pneumothoraces (49% vs. 25%, P < .05) and had positive Adson tests (86% vs. 61%, P < .02).
  
  
  CONCLUSIONS
  Compression of the subclavian vein or artery on duplex ultrasonography can assist in NTOS diagnosis. Ipsilateral compression on abduction often correlates with Adson testing.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD, USA morlando@jhmi.edu.
authors.forename: Megan S
authors.initials: MS
authors.lastname: Orlando
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Kendall C
authors.initials: KC
authors.lastname: Likes
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Serene
authors.initials: S
authors.lastname: Mirza
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Ying Wei
authors.initials: YW
authors.lastname: Lum
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
mesh_terms: D000293:Adolescent; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D003251:Constriction, Pathologic; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000000981:diagnostic imaging*; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D013901:Thoracic Outlet Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult
keywords: duplex ultrasonography; first rib resection and scalenectomy; neurogenic thoracic outlet syndrome