CC BY 4.0 · European J Pediatr Surg Rep. 2022; 10(01): e89-e92
DOI: 10.1055/s-0042-1748316
Case Report

Thoracic Outlet Syndrome after Minimally Invasive Repair of Pectus Excavatum in a 15-Year-Old Boy: A Case Report

1   Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Alameda Prof. Hernani Monteiro, Porto, Porto, Portugal
,
1   Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Alameda Prof. Hernani Monteiro, Porto, Porto, Portugal
,
Joana Monteiro
1   Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Alameda Prof. Hernani Monteiro, Porto, Porto, Portugal
,
Norberto Estevinho
1   Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Alameda Prof. Hernani Monteiro, Porto, Porto, Portugal
,
Mariana Borges-Dias
1   Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Alameda Prof. Hernani Monteiro, Porto, Porto, Portugal
› Author Affiliations

Abstract

Nuss procedure has become the treatment of choice in pectus excavatum mainly because of the excellent functional and cosmetic results. Despite the good results, several complications have been reported. The aim of this study is to describe a case of thoracic outlet syndrome (TOS) after Nuss procedure and review the management of such rare complication. A 15-year-old boy otherwise healthy was submitted to Nuss procedure, with no perioperative complications. Two-weeks later, the patient complained of right-hand paresthesia, progressive weakness of the right arm and coldness. After imaging and electromyography, TOS diagnosis was established. Removal of the bar was proposed but refused by the patient. Conservative management with rehabilitation exercising and nerve nourishing was initiated. At 7 months, the patient recovered arm and hand function. Abrupt structural changes of thoracic cavity with marked elevation of the upper chest induce nerve and vascular compression arousing a TOS and should be acknowledged as one potential complication of Nuss procedure. Conservative management can be an alternative treatment to bar removal, showing good results on functional recovery in early stages of compression.



Publication History

Received: 17 July 2021

Accepted: 02 March 2022

Article published online:
19 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Obermeyer RJ, Goretsky MJ. Chest wall deformities in pediatric surgery. Surg Clin North Am 2012; 92 (03) 669-684 , ix
  • 2 Brochhausen C, Turial S, Müller FK. et al. Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg 2012; 14 (06) 801-806
  • 3 Lawson ML, Mellins RB, Paulson JF. et al. Increasing severity of pectus excavatum is associated with reduced pulmonary function. J Pediatr 2011; 159 (02) 256-61.e2
  • 4 Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Ann Cardiothorac Surg 2016; 5 (05) 422-433
  • 5 Leonhardt J, Kübler JF, Feiter J, Ure BM, Petersen C. Complications of the minimally invasive repair of pectus excavatum. J Pediatr Surg 2005; 40 (11) e7-e9
  • 6 Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (04) 545-552
  • 7 Hebra A, Swoveland B, Egbert M. et al. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg 2000; 35 (02) 252-257 , discussion 257–258
  • 8 Kılıç B, Demirkaya A, Turna A, Kaynak K. Vascular thoracic outlet syndrome developed after minimally invasive repair of pectus excavatum. Eur J Cardiothorac Surg 2013; 44 (03) 567-569
  • 9 Zhang W, Pei Y, Liu K, Tan J, Ma J, Zhao J. Thoracic outlet syndrome (TOS): a case report of a rare complication after Nuss procedure for pectus excavatum. Medicine (Baltimore) 2018; 97 (36) e11846
  • 10 Lee SH, Ryu SM, Cho SJ. Thoracic outlet syndrome after the Nuss procedure for the correction of extreme pectus excavatum. Ann Thorac Surg 2011; 91 (06) 1975-1977
  • 11 Nagasao T, Morotomi T, Kuriyama M. et al. Thoracic outlet syndrome after the Nuss procedure for pectus excavatum: Is it a rare complication?. J Plast Reconstr Aesthet Surg 2017; 70 (10) 1433-1439
  • 12 Kim JJ, Park HJ, Park JK, Cho DG, Moon SW. A study about the costoclavicular space in patients with pectus excavatum. J Cardiothorac Surg 2014; 9 (01) 189
  • 13 Watson LA, Pizzari T, Balster S. Thoracic outlet syndrome part 1: clinical manifestations, differentiation and treatment pathways. Man Ther 2009; 14 (06) 586-595
  • 14 Oates SD, Daley RA. Thoracic outlet syndrome. Hand Clin 1996; 12 (04) 705-718
  • 15 Watson LA, Pizzari T, Balster S. Thoracic outlet syndrome part 2: conservative management of thoracic outlet. Man Ther 2010; 15 (04) 305-314