Thoracic Outlet Syndrome (TOS) Information

Migraine, carpal tunnel syndrome, reflex dystrophy, dystonia, fibromyalgia, impingement, and thoracic outlet syndrome are clinical diagnoses. They are not pathological ( fascial plane alteration ) diseases. They have a pathological cause. The radiologist must know anatomy to make an accurate diagnosis. You only see what you know!

The terms neurogenic and neurovascular are misconceptions. They are clinical terms. Nerves DO have a blood supply! (arteries, veins, and lymphatics) Image the artery and you image the nerve that binds to the artery for its nutrient blood supply. If you compress a nerve you compress the blood supply. Any decrease in venous return increases intrathoracic, intracranial, and intraabdominal pressure that triggers TOS complaints¹.

Migraine patients with TOS present with upper extremity pain and paresthesias; migrainous headache with or without visual changes (floaters and/or blurred vision); tinnitus; facial, back, chest and leg pain²; muscle spasms and dystonia, syncope, and hypertension. Some patients present with chronic, debilitating gastrointestinal complaints beyond the nausea and vomiting of the migraine attack and in addition to the usual TOS symptoms³.

Dr. James D. Collins monitors bilateral MRI, MRA, MRV brachial plexus at the imaging console without contrast injections and displays landmark anatomy according to grayscale proton density.

This is one of many legal landmark cases of Thoracic Outlet Syndrome where the use of bilateral MRI/MRA/MRV brachial plexus imaging displayed one of the anatomic causes of TOS. Leslie S. Caplan and Federal Judiciary US District Court⁴.

• Download a video of Dr. James D. Collins of UCLA Radiology annotating and interpreting a sample 3D Brachial Plexus MRI/MRA/MRV of a patient with bilateral Thoracic Outlet Syndrome.

• Visit the 3D Brachial Plexus MRI/MRA/MRV Annotated Image Gallery.

• View a list of physicians and other healthcare providers familiar with treating Thoracic Outlet Syndrome.