Images in Vascular Medicine Pectoralis minor syndrome - A forgotten vascular compression syndrome.

Abstract

Patient A is a 38-year-old male with left arm pain, swelling, and discoloration for 6 months. Exam was notable for prominent superficial venous collaterals over the left upper arm and shoulder extending into his chest (Urschel’s sign; Panel A, arrows). Symptoms worsened with an elevated arm stress test (EAST) maneuver. Duplex displayed a dampened respirophasic waveform in the left subclavian vein. Venography showed axillary vein obstruction in adducted (Panel B-1, blue arrow) and neutral positions with collateral flow (Panel B-2, blue and yellow arrows). With abduction, axillary vein obstruction was released with improved flow (Panel B-3, green arrow). Patient B is a 36-year-old male with progressive bilateral arm erythema and claudication for 1 year. Arm elevation elicited a left subclavian bruit and improved bilateral blanching arm erythema. The EAST maneuver elicited pain in both arms. The wrist–brachial index (WBI) showed dampened waveforms with both arms in 180 degrees and military positions compared to baseline (Panel C-1). Duplex showed continuous waveforms in subclavian and axillary