Imaging in VTOS

Venous thoracic outlet syndrome (most commonly spontaneous upper extremity deep vein thrombosis) originates from repetitive compression of the subclavian vein as it traverses anteriorly between the first rib and the clavicle. A good history and detailed physical exam with replication of the arm and shoulder movements that reproduce the symptomatology may establish the diagnosis of VTOS. If venous thoracic outlet syndrome (VTOS) is suspected, Duplex ultrasound imaging of the axillary-subclavian veins will provide a cost-effective, relatively sensitive method for confirming the diagnosis. If the diagnosis is not well established by non-invasive means, catheter-based upper extremity venography, non-invasive dynamic CT venogram, or MR venogram will verify the diagnosis. Percutaneous catheter-based venography is confirmatory, and is almost always performed due to the need in most cases for therapeutic intervention.