Thoracic outlet syndrome (TOS) refers to a group of conditions caused by extrinsic compression of neurovascular structures at the thoracic outlet. Arterial TOS (aTOS) is the rarest form and may present with upper limb ischemic symptoms such as pain, coldness, pallor, and numbness, most often due to bony abnormalities such as a cervical rib. We report the case of a 19-year-old woman on combined oral contraceptive therapy who presented with acute ischemia of the right upper limb. Duplex ultrasound and computed tomography angiography revealed thrombosis of the right subclavian artery in the setting of a right cervical rib. The patient underwent urgent thrombectomy followed by definitive decompression through supraclavicular resection of the supernumerary rib. This case illustrates a rare presentation of aTOS in a young patient and highlights the importance of prompt recognition and appropriate surgical management.
Grilli et al. (2026) studied this question.