Thoracic outlet syndrome caused by tumor of the first rib.

We report a new case of thoracic outlet syndrome caused by a tumor of the first rib and review 11 other reports found in the literature. A 25-year-old man was admitted with thoracic outlet syndrome in the C8-T1 nerve roots. The first rib was removed through a supraclavicular approach with excision of the medial clavicle. All symptoms disappeared. On histologic examination fibrous dysplasia was found in the rib. Tumors of the first rib are uncommon and are rarely responsible for thoracic outlet syndrome. When the tumor is very large, as in our case, we recommend a supraclavicular approach associated with excision of the medial clavicle. During the liberation of the brachial plexus, great care should be exercised to avoid nerve injuries. Because malignancy of the tumor cannot be eliminated with certainty before or during the operation, wide excision of the entire rib is recommended.