Infraclavicular subpectoral lipoma causing thoracic outlet syndrome

tINTRODUCTION: Thoracic outlet syndrome (TOS) includes a group of disorders caused by extrinsic com-pression of neurovascular structures between the 1st rib and clavicle. It usually presents as an enlargingneck mass, with shoulder or upper limb pain, weakness, paresthesias and impalpable radial pulse (Ray-naud’s phenomenon). PRESENTATION OF CASE: We report a rare case of TOS caused by an infraclavicular subpectoral lipomathat, although challenging because of limited access and proximity of vital neurovascular structures,was successfully removed through a simple transaxillary incision with an excellent esthetic result. Thepatients is symptom-free 6 months after surgery. DISCUSSION: Multiplicity of symptoms makes causes, diagnosis, and treatment of TOS controversial.Accurate diagnosis of TOS can be a substantial challenge in practice, because of a lack of physician aware-ness, overlapping of clinical features, and an absence of clearly defined diagnostic criteria. TOS may beassociated with the presence of a benign subpectoral mass like lipomas, that seldom have an irregulardistribution that involve neurovascular structures. CONCLUSION: Although benign soft tissue tumors infraclavicular subpectoral lipomas may exert pressureon neurovascular surrounding structures during their progressive expansion and cause TOS. Therefore,a thorough preoperative study by radiological imaging such as MRI or neurophysiological test shouldalways be performed in order to prevent unintentional lesions of the involved axillo-subclavicular plexusand plan correct surgical procedure.