Congenital Abnormalities, Cervical Ribs, and Related Bony Abnormalities

Articulating Cervical Rib - A Culprit Often Overlooked on Imaging! : Review Article

“…6). Thoracic outlet syndrome [12] refers to compression of the neurovascular bundle within the thoracic outlet [9]. Based on the structure being compressed it can be symptomatically and pathologically classified into: Neurogenic TOS: Compression brachial plexal cords or sympathetic chain [3].…”

Articulating Cervical Rib - A Culprit Often Overlooked on Imaging! : Review Article

“…6). Thoracic outlet syndrome [12] refers to compression of the neurovascular bundle within the thoracic outlet [9]. Based on the structure being compressed it can be symptomatically and pathologically classified into: Neurogenic TOS: Compression brachial plexal cords or sympathetic chain [3].…”

Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome

“…Rib resection: the amount of rib (cervical or first) resection should be defined Total: includes all rib from the transverse process of the spine to the sternum Posterior: removal from the subclavian artery to the transverse process of the spine Anterior: removal from the sternum to the subclavian artery Partial: partial rib removal not meeting any of the definitions above Supraclavicular approach: an incision solely above the clavicle (implies posterior rib removal) Infraclavicular approach: an incision solely below the clavicle (implies anterior rib removal) Paraclavicular approach: two incisions, one above and one below the clavicle (implies total rib removal) Transaxillary approach: an incision in the axilla (implies anterior rib removal, although total resection is possibledreports must specify) Posterior approach: any approach through the posterior structures Sternoclavicular rotation: exposure maintaining integrity of the sternoclavicular joint, performing a first interspace partial sternotomy, and rotating this upward for venous exposure with reconstruction afterward 5 Partial claviculectomy: removal of the medial twothirds (or more) of the clavicle, including disarticulation of the sternoclavicular joint Brachial plexus neurolysis: thorough débridement of investing muscle, scar, and other tissue surrounding the brachial plexus Endovenous intervention: any catheter-based, endoluminal intervention (angioplasty or stenting) directed at the axillosubclavian vein Intra-arterial intervention: any catheter-based, endoluminal intervention (angioplasty or stenting) directed at the axillosubclavian or other arteries Endovascular intervention: any catheter-based intervention to a blood vessel; the specific vessel should be described (and whether arterial or venous described or ascertained by context) Surgical venoplasty: open surgical repair of a damaged vein Cervical rib: a true rib (defined as the presence of an articulation) arising at the C7 level Elongated C7 transverse process: a C7 transverse process that extends beyond a line drawn between the C6 and T1 transverse processes and does not have an articulation with the vertebral body (ie, is part of that bone) 6 Ligamentous band: any band connecting bone structures in the thoracic outlet; the origination and termination should be described Scalenectomy: the qualifier anterior or middle should always precede this term Partial: anterior scalene muscle fibers removed through the transaxillary or infraclavicular approach; this implies removal of no more than 25% of the muscle Total: removal of the entire anterior scalene from rib to its origination at the spine (this can be done only through a supraclavicular approach) Subclavius muscle and tendon: the muscle and its tendinous insertion into the first rib and sternum Scalene minimus: the term used to describe muscle tissue that passes between roots of the brachial plexus, often inserting onto the first rib or to the extrapleural fascia (Sibson fascia) anterior to the subclavian artery…”

Articulating Cervical Rib - A Culprit Often Overlooked on Imaging! : Review Article

“…6). Thoracic outlet syndrome [12] refers to compression of the neurovascular bundle within the thoracic outlet [9]. Based on the structure being compressed it can be symptomatically and pathologically classified into: Neurogenic TOS: Compression brachial plexal cords or sympathetic chain [3].…”

Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome

“…Rib resection: the amount of rib (cervical or first) resection should be defined Total: includes all rib from the transverse process of the spine to the sternum Posterior: removal from the subclavian artery to the transverse process of the spine Anterior: removal from the sternum to the subclavian artery Partial: partial rib removal not meeting any of the definitions above Supraclavicular approach: an incision solely above the clavicle (implies posterior rib removal) Infraclavicular approach: an incision solely below the clavicle (implies anterior rib removal) Paraclavicular approach: two incisions, one above and one below the clavicle (implies total rib removal) Transaxillary approach: an incision in the axilla (implies anterior rib removal, although total resection is possibledreports must specify) Posterior approach: any approach through the posterior structures Sternoclavicular rotation: exposure maintaining integrity of the sternoclavicular joint, performing a first interspace partial sternotomy, and rotating this upward for venous exposure with reconstruction afterward 5 Partial claviculectomy: removal of the medial twothirds (or more) of the clavicle, including disarticulation of the sternoclavicular joint Brachial plexus neurolysis: thorough débridement of investing muscle, scar, and other tissue surrounding the brachial plexus Endovenous intervention: any catheter-based, endoluminal intervention (angioplasty or stenting) directed at the axillosubclavian vein Intra-arterial intervention: any catheter-based, endoluminal intervention (angioplasty or stenting) directed at the axillosubclavian or other arteries Endovascular intervention: any catheter-based intervention to a blood vessel; the specific vessel should be described (and whether arterial or venous described or ascertained by context) Surgical venoplasty: open surgical repair of a damaged vein Cervical rib: a true rib (defined as the presence of an articulation) arising at the C7 level Elongated C7 transverse process: a C7 transverse process that extends beyond a line drawn between the C6 and T1 transverse processes and does not have an articulation with the vertebral body (ie, is part of that bone) 6 Ligamentous band: any band connecting bone structures in the thoracic outlet; the origination and termination should be described Scalenectomy: the qualifier anterior or middle should always precede this term Partial: anterior scalene muscle fibers removed through the transaxillary or infraclavicular approach; this implies removal of no more than 25% of the muscle Total: removal of the entire anterior scalene from rib to its origination at the spine (this can be done only through a supraclavicular approach) Subclavius muscle and tendon: the muscle and its tendinous insertion into the first rib and sternum Scalene minimus: the term used to describe muscle tissue that passes between roots of the brachial plexus, often inserting onto the first rib or to the extrapleural fascia (Sibson fascia) anterior to the subclavian artery…”

Articulating Cervical Rib - A Culprit Often Overlooked on Imaging! : Review Article

“…6). Thoracic outlet syndrome [12] refers to compression of the neurovascular bundle within the thoracic outlet [9]. Based on the structure being compressed it can be symptomatically and pathologically classified into: Neurogenic TOS: Compression brachial plexal cords or sympathetic chain [3].…”

Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome

“…Rib resection: the amount of rib (cervical or first) resection should be defined Total: includes all rib from the transverse process of the spine to the sternum Posterior: removal from the subclavian artery to the transverse process of the spine Anterior: removal from the sternum to the subclavian artery Partial: partial rib removal not meeting any of the definitions above Supraclavicular approach: an incision solely above the clavicle (implies posterior rib removal) Infraclavicular approach: an incision solely below the clavicle (implies anterior rib removal) Paraclavicular approach: two incisions, one above and one below the clavicle (implies total rib removal) Transaxillary approach: an incision in the axilla (implies anterior rib removal, although total resection is possibledreports must specify) Posterior approach: any approach through the posterior structures Sternoclavicular rotation: exposure maintaining integrity of the sternoclavicular joint, performing a first interspace partial sternotomy, and rotating this upward for venous exposure with reconstruction afterward 5 Partial claviculectomy: removal of the medial twothirds (or more) of the clavicle, including disarticulation of the sternoclavicular joint Brachial plexus neurolysis: thorough débridement of investing muscle, scar, and other tissue surrounding the brachial plexus Endovenous intervention: any catheter-based, endoluminal intervention (angioplasty or stenting) directed at the axillosubclavian vein Intra-arterial intervention: any catheter-based, endoluminal intervention (angioplasty or stenting) directed at the axillosubclavian or other arteries Endovascular intervention: any catheter-based intervention to a blood vessel; the specific vessel should be described (and whether arterial or venous described or ascertained by context) Surgical venoplasty: open surgical repair of a damaged vein Cervical rib: a true rib (defined as the presence of an articulation) arising at the C7 level Elongated C7 transverse process: a C7 transverse process that extends beyond a line drawn between the C6 and T1 transverse processes and does not have an articulation with the vertebral body (ie, is part of that bone) 6 Ligamentous band: any band connecting bone structures in the thoracic outlet; the origination and termination should be described Scalenectomy: the qualifier anterior or middle should always precede this term Partial: anterior scalene muscle fibers removed through the transaxillary or infraclavicular approach; this implies removal of no more than 25% of the muscle Total: removal of the entire anterior scalene from rib to its origination at the spine (this can be done only through a supraclavicular approach) Subclavius muscle and tendon: the muscle and its tendinous insertion into the first rib and sternum Scalene minimus: the term used to describe muscle tissue that passes between roots of the brachial plexus, often inserting onto the first rib or to the extrapleural fascia (Sibson fascia) anterior to the subclavian artery…”