ABSTRACT
Thoracic outlet syndrome (TOS) manifests as a spectrum of symptoms that are produced by compression of neurovascular bundles as they pass through the scalene muscles, clavicle, and the first rib. When a vascular structure like subclavian artery is involved, TOS may result in serious complications, such as thromboembolism at distal extremities or, more rarely, the brain. Here, we present a case of 25-year-old male presenting with Raynaud's phenomenon, finger tip necrosis, and left-sided hemiplegia secondary to thromboembolism associated with arterial TOS. Radiologic studies, including simple X-ray, neck computed tomography (CT) angiography, thoracic aortography, and cerebral angiography, revealed anomalous articulation of the right first rib to the second rib, right subclavian artery stenosis with poststenotic dilatation and intramural thrombus, and thromoboembolism of the right distal internal carotid artery (ICA). The patient successfully underwent resection of the anterior scalene muscle and embolectomy.