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Thoracic outlet syndrome (TOS) is not a single entity. By definition, TOS is compression of the neurovascular bundle in the thoracic outlet area eliciting symptoms in the upper extremity. The neurovascular bundle, comprising nerve, artery, and vein, gives rise to three types of TOS: neurogenic, arterial, and venous. When using the term TOS, most people are referring to the neurogenic form which comprises over 95% of all TOS patients; venous TOS makes up 3% and arterial TOS 1%. Because the optimal approach for each of the three types is different, it is important to define which type of TOS is being discussed.

Pectus excavatum is a chest-wall deformity occurring in approximately 1 in 400 individuals and is identified four times more commonly in males than females. Based upon this figure, a region with 30,000 live births per year (approximately what would occur in an area with a population of 2,000,000) would expect to have 75 children born with pectus excavatum per year. The underlying etiology is unknown. More than 90% have some evidence of depression of the sternum at birth with progression of the severity of the deformity over the course of their growth and development. Many patients will note that a family member also has this deformity, although no clear genetic predisposition to this as an isolated entity has been identified. Patients with connective tissue disorders, such as Marfan’s syndrome, have a fairly high incidence of pectus excavatum or pectus carinatum. Because these disorders are generally of genetic origin, there is likely a chromosomal correlation in this instance.