204 Thoracic Outlet Syndrome After Nuss Procedure for Pectus Excavatum: An Unusual Complication of a Common Procedure

Abstract Pectus excavatum is a common abnormality of the chest wall with variable severity. The Nuss procedure was introduced in 1987 and has since become a standard modality of treatment for this condition. This operation has a well-established safety record and significant complications are rare. Case report of a 21-year-old male with pectus exavatum operated on in our department. Symptoms discovered during post-operative follow up: - He complained of purple discolouration and swelling of his left hand, which was positional, particularly pronounced with arms hanging by his side, and relieved when he lifted his arm overhead.- This was also accompanied by his left arm feeling colder to the touch when compared to his right arm. Examination findings: - At rest, no objective sensory deficits were elicited.- On arm elevation and external rotation, the swelling and congestion resolved, but the arm turned white, with a positive Adson’s test.- Findings were highly suggestive of Thoracic Outlet syndrome Imaging findings: CT Angiogram: abnormally fused first and second rib on the left. Obvious kink in the artery suggesting presence of a cervical band. Operative findings: - The anterior scalene was abnormally deep and attached to the lateral and anterior surface of rib and tightly fibrous.- uscle was divided at its insertion and was found to encircle the Subclavian artery completely Conclusions