CTICasesSubclavian Artery Thrombosis due to Anomalous First Rib
Imaging findings
Chest radiography reveals a shortened, anomalous first rib on the left, demonstrating an atypical morphology. Contrast-enhanced MR angiography of the upper extremity demonstrates focal, acute thrombosis of the left subclavian artery directly at the thoracic outlet, compressed within the interscalene triangle by the anomalous rib and surrounding scalene musculature.
Key takeaways
Vascular thoracic outlet syndrome can be precipitated by congenital bony abnormalities of the thoracic inlet, such as a cervical rib or an anomalous, shortened first rib. Chronic mechanical compression of the subclavian artery can lead to arterial wall injury, stenosis, post-stenotic aneurysm formation, or acute thrombosis, often requiring surgical rib resection, scalenectomy, and arterial bypass.
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