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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Material and method
 ::  Results and disc...
 ::  Acknowledgment
 ::  References

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ORIGINAL ARTICLE
Year : 1990  |  Volume : 36  |  Issue : 3  |  Page : 154-7

Impedance plethysmographic observations in thoracic outlet syndrome.


Department of Cardiovascular, Seth G. S. Medical College, Parel, Bombay, Maharashtra.

Correspondence Address:
Department of Cardiovascular, Seth G. S. Medical College, Parel, Bombay, Maharashtra.


  ::  Abstract

Forty patients with symptoms of neuro-vascular compression in the upper extremities were subjected to impedance plethysmographic study using Parulkar's method. Two patients recorded decreased blood flow (BFI) in supine position and were diagnosed as having partial occlusion at subclavian level. Sixteen of the patients recorded decreased BFI on 90 degrees abduction and hyper-abduction. Twelve of these patients had radiological evidence of anomalous cervicle ribs. In remaining four patients extrinsic impression on the subclavian artery due to fibrous deposits was confirmed by arteriography. Remaining 22 patients recorded normal impedance plethysmograms. Impedance plethysmography thus provided a non-invasive modality for confirmation of vascular compression in thoracic outlet syndrome.

How to cite this article:
Nerurkar S N, Jindal G D, Pedhenekar S A, Gupta D K, Deshpande A K, Deshmukh H L, Parulkar G B. Impedance plethysmographic observations in thoracic outlet syndrome. J Postgrad Med 1990;36:154


How to cite this URL:
Nerurkar S N, Jindal G D, Pedhenekar S A, Gupta D K, Deshpande A K, Deshmukh H L, Parulkar G B. Impedance plethysmographic observations in thoracic outlet syndrome. J Postgrad Med [serial online] 1990 [cited 2018 Sep 24];36:154. Available from: http://www.jpgmonline.com/text.asp?1990/36/3/154/842




  ::   Introduction Top

Arteriography needs to be employed for objective detection of vascular compression in thoracic outlet syndrome (TOS), in the absence of an efficient non-invasive modality. In the last decade, Parulkar et al[7] introduced dZ/dt waveform in impedance plethysmography for the assessment of peripheral blood circulation. This method was observed to be highly sensitive and specific in the diagnosis of aortic occlusive diseases[3],[4], peripheral arterial occlusive diseases[4],[5] and venous disorders[6]. This development led the authors to employ Parulkar's method for the objective assessment of vascular compression in thoracic outlet syndrome. In this paper we present the impedance plethysmographic observations in 40 patients suspected with thoracic outlet syndrome.

  ::   Material and method Top

Forty patients (22 males and 18 females) in the age group of 15 to 55 years, with the symptoms of neuro-vascular compression in upper extremities were subjected to this study. Eighteen of these patients had radiological evidence of anomalous cervical rib.
Impedance plethysmographic study was carried out at Non-invasive Vascular Laboratory, King Edward Memorial Hospital (32 patients) and Isotope Unit JJ Hospital (8 patients) in the manner described by Bhuta et al[2]. Blood flow index (BFI) and differential pulse arrival time (DPAT) were calculated from IPG data as described elsewhere in this volume[1],[2].
IPG data was first analysed to rule out possibility of aortic or arterial occlusive disease using the criteria of Deshpande et al[3] and Jindal et al[5] and then diagnosis of thoracic outlet syndrome was made using the following criteria:
1. BM (supine) within normal limits upto the wrist level in both the upper extremities with decrease in BH at forearm location on 900 abduction and hyper-abduction in one or both the limbs is suggestive of thoracic outlet syndrome.
2. The degree of vascular compression is higher if BFI decreases on 90 abduction and hyper-abduction, than that on hyperabduction alone.
Arteriography was carried out in eight patients at Radiology Department of King Edward Memorial Hospital, Mumbai, using the standard procedure for TOS.

  ::   Results and discussion Top

In this study, 22 out of 40 patients recorded BM > 1.45 at all the locations in both the upper extremities in supine as well as on abduction and hyper-abduction. Six of these patients had radiological evidence of anomalous cervicle ribs. However, arteriography in 2 of these 6 patients was found to be normal confirming IPG observations and therefore the same was not performed in remaining 4 patients.
Two patients recorded BM < 1.45 at all locations in the affected limb in supine position without any significant change in DPAT. IPG diagnosis in these patients was partial occlusion at subclavian level in the affected limb. Arteriography showed long segmental narrowing of right subclavian artery in one patient and partial embolic occlusion of left axillary artery in the other patients, thus corroborating the IPG diagnosis.
Eleven patients recorded decrease in BH (< 1.45) in the affected limb and 5 patients recorded decreased BM in both the limbs. Twelve of these patients showed anomalous cerivcle ribs in the X- ray chest and therefore angiographic correlation was considered unnecessary. In remaining four patients arteriographic findings were in agreement with IPG observations.
[Figure - 1] illustrates IPG waveforms recorded from a patient with bilateral vascular compression. As can be seen from the figure the amplitude of dZ/dt waveform is markedly reduced on hyperabduction in right upper extremity and on 90? abuuctlon as well as hyper-abduction in left upper extremity. The IPG diagnosis of bilateral TOS (L < R) in this patient is in agreement with anglographic findings.

  ::   Acknowledgment Top

The authors are thankful to Dr. (Mrs) Pragna Pai, Dean, Seth GS Medical College and King Edward Memorial Hospital, Dr. (Mrs) RA Maghotra, Head, Cardio-vascular and Thoracic Surgery Department, King Edward Memorial Hospital, Shri MK Gupta, Assoc. Director, E & I Group, BARC, Shri BR Bairi, Head, Electronics Division, BARC, Shri KR Gopalakrishnan, Head, Nuclear Instruments Section, BARC and Dr. SK Ganeriwal, Dean, Grant Medical College and JJ Hospital, Mumbai for providing facilities, infrastructure and encouragement in carrying out this study.

  ::   References Top

1. Babu JP, Jindal GD, Bhuta AC, Parulkar GB. Impedance plethysmography: basic principles. J Postgrad Med 1990; 36:57-63.  Back to cited text no. 1    
2.Bhuta AC, Babu JP, Jindal GD, Parulkar GB. Technical aspects of Impedance Plethysmography. J Postgrad Med 1990; 36:64-70.   Back to cited text no. 2    
3.Deshpande AK, Jindal GD, Babu JP, Nerurkar SN, Kelkar MD, Parulkar GB, et al. Diagnosis of aortic occlusive diseases using impedance plethysmography. J Postgrad Med 1990; 36:80-82.  Back to cited text no. 3    
4.Jindal GD, Kelkar MD, Bhardwaj PR, Dewoolkar SD, Suraokar SB, Babu JP, Parulkar GB, et al. Non-invasive diagnosis of aortic and arterial occlusive diseases using on-line impedance. Clinic (Italy): 1984; 2:3-14.  Back to cited text no. 4    
5.Jindal GD, Nerurkar SN, Pedlinckar SA, Babu JP, Kelkar MD, Deshpande AK, Parulkar GB, et al. Diagnosis of peripheral arterial occlusive diseases using impedance plethysmography. J Postgrad. Med 1990; 36:147-153.  Back to cited text no. 5    
6.Jindal GD, Pedhnekar SA, Nerurkar SN, Gupta DK, Masand KL, Deshmukh HL, Babu JP, Parulkar GB, et al. Diagnosis of venous disorders using impedance plethysniography. J Postgrad Med 1990; 36:158-163.  Back to cited text no. 6    
7.Parulkar GB, Padmashree RB, Bapat RD, Rege RV, Bhagtani KC, Jindal GD, et al. A new electrical impedance plethystnogram; Observations in peripheral arterial occlusive diseases. J Postgrad Med 1981; 26:66-72.   Back to cited text no. 7    

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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