Thoracic outlet syndrome secondary to hydroxyapatite deposition disease complicated by subclavian vein thrombosis.

Abstract

AIM: To present a case report of thoracic outlet syndrome secondary to hydroxyapatite deposition disease (HADD) effecting the subclavius muscle and costoclavicular ligament complicated by subclavian vein thrombosis. METHOD: An extensive literature review was performed examining uncommon and rare causes of thoracic outlet syndrome, as well as unusual sites of HADD, with particular reference to the subclavius muscle and costoclavicular ligament. RESULTS: The accessory muscle - subclavius posticus - has been implicated in thoracic outlet syndrome, however acquired diseases of the subclavius muscle, especially those pertaining to the thoracic outlet have not been described (1). Abnormal lateral insertion of the costoclavicular ligament can narrow the costoclavicular space causing venous compression, howeve acquired disorders of the ligament excluding trauma are scarce (2, 3). By far and away the most common site of hydroxyapatite deposition is within the shoulder, namely the supraspinatus tendon where it causes an acute calcific tendinitis (4). Such crystal deposition can occur within any tendon, bursa, joint capsule, periarticular soft tissue or ligament throughout the body. CONCLUSION: To our knowledge this is the first documented case of HADD causing thoracic outlet obstruction.