title: An unusual case of neurogenic thoracic outlet syndrome.
abstract: BACKGROUND
  Neurogenic thoracic outlet syndrome (nTOS) is the most common manifestation of thoracic outlet syndrome (TOS), accounting for more than 95% of cases. It is usually caused by cervical ribs, anomalies in the scalene muscle anatomy or post-traumatic inflammatory changes causing compression of the brachial plexus.
  
  
  METHODS
  We present an unusual case of nTOS caused by a cystic lymphangioma at the thoracic outlet, with only one case reported previously in the literature. We used a combined supraclavicular and transaxillary approach for complete removal, which resulted in excellent recovery of the patient.
  
  
  CONCLUSIONS
  Though lymphatic cysts may be commonly encountered in surgical practice, compression causing nTOS is extremely rare. The location of the lymphatic cyst with compression of the brachial plexus may provide a challenge for treatment. Surgical excision is the preferred method of management, with higher success rates than sclerotherapy.
  
  
  CONCLUSIONS
  Surgical excision to ensure complete removal of the cyst is recommended. Sclerotherapy may be used in cases where complete excision of the cyst wall may not be possible.
authors.affiliation: Dept. of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India. Electronic address: dr.yashvaidya@gmail.com.
authors.forename: Yash
authors.initials: Y
authors.lastname: Vaidya
authors.affiliation: Dept. of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India. Electronic address: 57sylvan@gmail.com.
authors.forename: Rajan
authors.initials: R
authors.lastname: Vaithianathan
keywords: Cystic lymphangioma; Neurogenic thoracic outlet syndrome; Transaxillary approach