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Poster - 1
Thoracic outlet syndrome from anomalous 8th cervical vertebrae ribs: a rare pediatric diagnosis
M Oumaya, PY Rabattu, C Saadi, PL Vérot, R Faguet, S Antoine, C Jacquier, C Piolat
Department of Pediatric Surgery, Children’s Hospital, University Hospital of Grenoble, Grenoble, France
Introduction:
Thoracic outlet syndrome (TOS) is extremely rare in pediatric patients, with only a few reported cases. By presenting a rare case of TOS caused by a cervical rib in a child, we emphasize the importance of considering this diagnosis in pediatric practice.
Case presentation:
We report the case of an 11-year-old boy, who presented with complaints of intermittent upper left limb numbness and pain when moving the left shoulder. The symptoms appeared over 3 years with observation of swelling in the left supraclavicular fossa. He didn’t have any obvious precipitating trauma and was otherwise well. Clinical examination revealed firm swelling of the left supraclavicular fossa, without signs of vascular compression, as confirmed by doppler ultrasound. Standard radiography identified bilateral cervical ribs. A CT angiography with three-dimensional reconstruction visualized an abnormal neo-articulation on the left between the anterior end of the cervical rib and the superior edge of the anterior arch of the first rib, which appears to cause partial stenosis of the subclavian artery. Surgical intervention was indicated and performed via a supraclavicular approach. After identifying the subclavian artery, the lower trunk of the brachial plexus, and the phrenic nerve, the neo-articulation and most of the cervical rib were resected. The postoperative course was uneventful, with complete resolution of pain and clinical symptoms.
Conclusion:
TOS is rare in children, and cervical ribs are an uncommon cause. When articulated with the first rib, they can become symptomatic. This case prompted a literature review on this rare pediatric condition, highlighting the importance of recognizing it when surgery may offer symptom relief. A thorough clinical and radiological assessment, supported by vascular specialists, is crucial to guide therapeutic decisions. The resection of a supernumerary cervical rib via a supraclavicular approach can lead to complete symptom resolution and rapid recovery.