title: Ultrasonographic Identification of Fibromuscular Bands Associated with Neurogenic Thoracic Outlet Syndrome: The "Wedge-Sickle" Sign.
abstract: Thoracic outlet syndrome (TOS) is a disorder characterized by compression of the lower trunk of the brachial plexus, most often in association with anomalous congenital fibromuscular bands in the scalenic region. Early diagnosis is important, because the neurologic deficit associated with TOS may be irreversible. Using high-resolution ultrasound, we investigated 20 consecutive patients with clinical signs suggestive of TOS (all females, average age: 40.4 ± 14.9 y) and 25 control patients. In 19 patients, we identified a hyper-echoic fibromuscular structure at the medial edge of the middle scalene muscle, which indented the lower trunk of the brachial plexus ("wedge-sickle sign"). It was associated with the significant enlargement (p < 0.0001) and hypo-echogenicity of the lower trunk. This novel and distinctive ultrasonographic sign allows pre-surgical identification of anomalous fibromuscular bands causing TOS. It is especially useful in patients without neurologic deficit, in whom the diagnosis may not be as straightforward.
authors.affiliation: MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Budapest, Hungary. Electronic address: aranyi.zsuzsanna@med.semmelweis-univ.hu.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Arányi
authors.affiliation: MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Budapest, Hungary.
authors.forename: Anita
authors.initials: A
authors.lastname: Csillik
authors.affiliation: Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm, Berlin, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Böhm
authors.affiliation: Department of Neurology, Städtisches Klinikum Dessau, Dessau-Rosslau, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schelle
mesh_terms: D000328:Adult; D000368:Aged; D001917:Brachial Plexus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: Fibromuscular bands; High-resolution ultrasound; Thoracic outlet syndrome; Wedge-sickle sign