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1146 - Thoracic Outlet Syndrome: Key Symptoms and Risk Factors Before a Stroke Occurs in an Adolescent

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

KH

Kathryn Horton, BS

Medical Student
UTHealth Houston
Houston, Texas, United States

Co-Author(s)

RP

Rebekah J. Park, BA

Medical Student
University of Texas Health Science Center at Houston
Houston, Texas, United States
EB

Ethan Bui, BS

Medical Student
UTHealth Houston
Houston, Texas, United States
MN

Michael V. Nguyen, MD

Assistant Professor
UTHealth Houston
Houston, Texas, United States

Objectives: Thoracic outlet syndrome (TOS) is a compression within the thoracic outlet. Arterial TOS, while the rarest form of TOS, has the most drastic effects on morbidity and mortality, including thromboembolic strokes in children and adolescents. Having a stroke at such a young age places a tremendous burden on patients and their families. A standardized protocol is needed for diagnosing arterial TOS in the pediatric population, as it often goes undiagnosed until a life-threatening event such as a stroke occurs. This report aims to raise awareness of arterial TOS's symptoms and risk factors to enable timely intervention and prevent a major thromboembolic event from occurring in a child.

Design: The review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 protocol. A systematic search was conducted across PubMed, Embase, CINAHL, and Cochrane. The inclusion criteria included children under 18, English language, symptoms, risk factors, human subjects, and arterial TOS. A total of 526 articles were identified. Of those, 188 external duplicates were removed. The remaining 338 were reviewed by three people and narrowed down to 11 papers based on the inclusion criteria.

Results: All 11 of the studies included in our analysis were case reports or case series. Among 20 patients with ages ranging from 8-17, most patients fell in the 14.75-17-year-old category. Common risk factors identified were female sex and bony abnormalities. Common symptoms identified were paresthesia, limb ischemia, discoloration of affected extremity, weakness, non-palpable radial pulse, and arm pain.

Conclusions:
Given the rarity of arterial TOS and the devastating consequences of the syndrome in children, further research is critically needed. The current scarcity of data limits our potential for effective early diagnosis. Future research may point to the establishment of standardized diagnostic protocols and ultimately reduce the rate of life-altering complications for children with arterial TOS.