Pectoralis minor syndrome: Report of two cases and review
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Hellenic Journal of Surgery (2017) 89:3-4, 149-152
Pectoralis Minor Syndrome: Report of Two Cases and Review Rizniotopoulou PA, Apostolou CE, Fountoukis TN, Samaras AA, Skandalos IK
Abstract Pectoralis minor syndrome (PMS) is an infrequent entity that mimics thoracic outlet syndrome. PMS is characterized by axillary vein stenosis/obstruction below the clavicle, due to compression by the pectoralis minor muscle. The typical clinical symptoms are pain, weakness, numbness, paresthesia, cyanosis and swelling of the upper extremity, aggravated by exercise. Two cases are presented here of right-sided PMS of symptomatic stenosis of the axillary vein. The importance is emphasized of diagnosis by dynamic venography imaging and treatment by surgery. Key words: Pectoralis minor syndrome; axillary vein; venography; thoracic outlet syndrome
Introduction Pectoralis minor syndrome (PMS) is an infrequent entity mimicking thoracic outlet syndrome (TOS). TOS is manifested with symptoms of external compression of the brachial plexus, subclavian artery and vein (i.e., the neurovascular bundle) in the scalene triangle bordered by the clavicle, first rib and scalene muscles above the clavicle [1]. PMS is characterized by axillary vein stenosis/obstruction below the clavicle, due to compression by the pectoralis minor muscle [2]. The typical clinical symptoms of PMS are pain, weakness, numbness, paresthesia, cyanosis and swelling of the upper extremity, aggravated by exercise [3,4]. The diagnosis is confirmed by imaging, and specifically dynamic venography, in functional positions of the upper extremity. Two cases are presented of PMS with symptomatic stenosis of the axillary vein, emphasizing the importance of diagnosis by dynamic venography imaging and treatment by surgery.
Report of Cases Two patients, a 20-year-old male and a 34-year-old female, are presented with complaints of recurrent mildly painful right arm swelling and cyanosis with dilatation of the superficial veins, of 3 and 6 months duration, respecRizniotopoulou PA, Apostolou CE, Fountoukis TN, Skandalos IK Surgical Department, General Hospital “Agios Pavlos”, Thessaloniki, Greece Samaras AA 2nd Surgical Clinic, General Hospital “Papageorgiou”, Thessaloniki, Greece Corresponding author: Rizniotopoulou Paraskevi Surgical Department, General Hospital “Agios Pavlos”, N. Rissio, PO Box 242, 57001 Thessaloniki, Greece Tel.: +30 2392072280, +30 6932614334 e-mail: [email protected] Received 10 May 2017; Accepted 25 Aug 2017
Hellenic Journal of Surgery 89
tively. The symptoms were aggravated with exercise and on raising the arms, which provoked a feeling of tingling and numbness of the hand and cyanosis of the fingers. The medical history of both patients was free, and both reported intense activity of the upper extremities, the male during athletic activity and the female through use of the right arm at work. The laboratory investigation was normal in both patients. Chest and cervical spine X-rays showed no cervical rib or other cervical pathology. The imaging tests used fo
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