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Thoracic Outlet Syndrome with Subclavian Artery Thrombosis Undetectable by Magnetic Resonance AngiographyA Case Report
James T. Monica, MD1; Christopher J. Kwolek, MD2; Jesse B. Jupiter, MD3
1 Orthopaedic Teaching Office, Massachusetts General Hospital, GRB 622, 55 Fruit Street, Boston, MA 02114
2 Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, WAC 458, 55 Fruit Street, Boston, MA 02114
3 Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Massachusetts General Hospital, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jul 01;89(7):1589-1593. doi: 10.2106/JBJS.F.01253
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Acute vascular insufficiency in the upper limb suggests the possibility of an embolic phenomenon1-3. The most common source of upper-extremity emboli is from the subclavian artery, with less likely potential sources being the superficial palmar arch and cardiac vessels1. Thoracic outlet compression represents the most frequently reported cause of subclavian arterial disease1,2,4, and arterial-related problems associated with thoracic outlet compression, although extremely uncommon, have also been reported5. In addition to the detection of historical features and the performance of provocative maneuvers during the clinical examination, the use of noninvasive magnetic resonance angiography has been reported to be particularly helpful in the diagnosis of thoracic outlet compression6,7.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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