Congenital abnormalities of the great vessels trigger neurovascular and gastrointestinal symptoms in patients with thoracic outlet syndrome (TOS) and migraine: MRI, MRA and MRV

In migraine patients with thoracic outlet syndrome (TOS) bilateral multiplanar magnetic resonance imaging (MRI), angiography (MRA) and venography (MRV) of the brachial plexus display sequential images of the neck, thorax and shoulder girdle and demonstrate costoclavicular compression abnormalities of the great vessels and neurovascular bundles without the use of contrast material. Migraine patients with TOS present with upper extremity pain and paresthesias; migrainous headache with or without visual changes; tinnitus; facial, back and leg pain; muscle spasms and dystonia, and syncope. Some patients present with chronic, debilitating gastrointestinal complaints beyond the nausea and vomiting of the migraine attack and in addition to the usual TOS symptoms. Bilateral multiplanar imaging was conducted on a 1.5 Tesla GE Signa LX (Clin. Anat. 1995; 8:–16), with the field of view modified to include the dural sinuses. Unexpectedly, these patients were found to have congenital anomalies of the aortic arch and the great vessels. Patients with TOS and congenital vascular abnormalities of the aortic arch and great vessels present with difficulty swallowing, pain on eating, gastroesophageal reflux and hoarseness. This presentation displays patients with right aortic arch, aberrant left subclavian artery and left superior vena cava, who presented with severe gastrointestinal symptoms along with the TOS and migraine complaints.