204 Thoracic Outlet Syndrome After Nuss Procedure for Pectus Excavatum: An Unusual Complication of a Common Procedure. (28th February 2022)

• Record Type: Journal Article
• Authors: Gopalaswamy, M.; Waterhouse, B.; Dunning, J.
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 1
• Publication Date: 2022-02-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac039.125
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Pectus excavatum is a common abnormality of the chest wall with variable severity. The Nuss procedure was introduced in 1987 and has since become a standard modality of treatment for this condition. This operation has a well-established safety record and significant complications are rare. Case report of a 21-year-old male with pectus exavatum operated on in our department. Symptoms discovered during post-operative follow up: - He complained of purple discolouration and swelling of his left hand, which was positional, particularly pronounced with arms hanging by his side, and relieved when he lifted his arm overhead. - This was also accompanied by his left arm feeling colder to the touch when compared to his right arm. Examination findings: - At rest, no objective sensory deficits were elicited. - On arm elevation and external rotation, the swelling and congestion resolved, but the arm turned white, with a positive Adson's test. - Findings were highly suggestive of Thoracic Outlet syndrome Imaging findings: CT Angiogram: abnormally fused first and second rib on the left. Obvious kink in the artery suggesting presence of a cervical band. Operative findings: - The anterior scalene was abnormally deep and attached to the lateral and anterior surface of rib and tightly fibrous. - uscle was divided at its insertion and was found to encircle the Subclavian artery completely Conclusions: The Nuss procedure for Pectus excavatum causes remodelling of the anterior chest wall. This can disrupt other anatomical structures causing significant morbidity. It is important to consider diagnoses such as Thoracic Outlet Syndrome when following up these patients.