A 39-year-old female patient presented with venous and neurogenic thoracic outlet syndrome, manifesting in positional pain and deep vein thrombosis (DVT) in the right upper extremity, accompanied by vascular redistribution. Her medical history was significant for surgical intervention for palmar hyperhidrosis (via a thoracoscopic approach) 15 years ago and second DVT in the right upper extremity in 2010, for which she received only limited anticoagulant treatment. She re-presented with symptoms suggestive of another DVT in the same region, meriting further investigation and management. Computed tomography (CT) angiography showed a decrease in the costoclavicular space in abduction (5.8 mm) when compared with the anatomical position (8.8 mm). Magnetic resonance (MR) angiography reported marked stenosis of the right subclavian vein in the costoclavicular space with forced arm-abduction maneuvers, completely reversed at rest. A non-pathological electromyogram (EMG) and magnetic resonance imaging (MRI) of the upper extremity showed a decrease in the lumen of the right subclavian vein up to 70–80%. After unsuccessful symptomatic treatment, physiotherapy, and rehabilitation, and given the recurrence of DVT after 15 years, a decision was made to operate to alleviate the thoracic outlet syndrome.
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