• Why do you need an imaging test for thoracic outlet syndrome (TOS) to assess soft tissues and rule out differential diagnoses like spinal cord issues? Curious about how this diagnostic tool can provide crucial insights into your health? Imaging tests play a vital role in identifying TOS, guiding treatment decisions, and ensuring accurate diagnosis of soft tissues for doctors and differential diagnoses.

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Table of Contents

A Young Man with a Dream

Jake Marcum is a young man with a dream. Since he was young, Jake knew he would be an elite swimmer. But his dream was interrupted in a surprising way. Follow Jake’s story as this elite swimmer overcomes TOS.

Jake Marcum took his first swimming lesson at the age of 5. By the age of 10, he was winning tournaments. Jake attended the prestigious McCallie private school in Chattanooga, Tennessee. Under the guidance of aquatics coach Stan Corcoran, Jake molded himself into an elite swimmer and competitor. Jake scored every year at the Tennessee state high school meet, and he graduated McCallie as an eight-time high school All-American. By the end of high school, Jake qualified for the Junior National Championship Series, with other top-ranked elite swimmers.

As Jake’s swimming prowess grew in high school, Jake drew the attention of swimming coach Ray Looze at Indiana University, the NCAA’s 3rd-ranked swim team. Subsequently, Jake committed to Indiana, and he eagerly anticipated the upcoming opportunities and challenges.

Mysterious Symptoms Develop

Just a few days before his commitment ceremony, Jake pushed his way through a strenuous swim practice. At the end of practice, Jake’s right arm suddenly appeared blue and swollen. Although initially alarmed at this development, Jake relaxed as these symptoms spontaneously receded. Photos taken of Jake during the commitment ceremony showed a happy young man.

The next day, however, Jake found himself unable to lift weights, and he sought out trainer and coach Timothy Bass. Coach Bass noticed that Jake’s right hand had suddenly turned a dark color, and he expressed concern that the blood flow in Jake’s arm had become compromised. The next morning, after Jake’s arm swelled to twice its normal size, Coach Bass reacted promptly and sent Jake to a local emergency room.

Jake’s Diagnosis of Venous Thoracic Outlet Syndrome

In the emergency room, alert doctors ordered an ultrasound study of the blood vessels of Jake’s right neck and shoulder. Jake and his father, cardiologist Dr. James Marcum, watched the ultrasound study with mounting concern. Jake (now a pre-med student) and his dad recognized a large blood clot in the large subclavian vein of his right arm. The radiologist confirmed the blood clot and the diagnosis of venous thoracic outlet syndrome.

Jake’s Dramatic and Inspiring Journey

We encourage everybody with an interest in TOS to watch Jake’s inspiring story, and to experience how an elite swimmer overcomes TOS. Witness Jake’s challenges and comebacks, as told by Jake, his family, coaches, and doctors. And make sure you visit and bookmark Jake’s website, Back in the Water, built by his dad, to learn more about Jake’s journey, and the team that led him through it.

Hear from Jake, the elite swimmer, up close and personal

We were honored to share some time with Jake on our live stream, and to learn about his adventure so far, as well as his exciting plans moving forward.

What is Venous Thoracic Outlet Syndrome?

Venous TOS occurs when a blood clot forms in the large vein draining one arm to the chest, the subclavian vein. This clot causes blood flow to slow or stop, causing blood and fluid to build up in the affected arm. Patients experience swelling and cyanosis (a dark blue color), in the affected arm.

How is Venous Thoracic Outlet Syndrome Diagnosed and Treated?

Venous TOS has many names, most commonly ‘effort thrombosis’ or ‘Paget-Schroetter Syndrome.’ Venous TOS is very uncommon, making up only 2 to 5% of all cases of thoracic outlet syndrome. Doctors typically diagnose venous TOS with ultrasound, less frequently with venography. Venography requires injection of dye into the arm with x-ray monitoring. Treatment depends on many variables, including the degree of blockage, the general health of the patient, and the presence or absence of blood clots elsewhere. Treatment includes dissolving the blood clot, either quickly with thrombolysis or slowly with anti-coagulation, followed by either stent placement (a flexible metal cage that keeps the vein open), removal of the first rib, or both. After treatment, doctors often perform venograms at various stages to insure the absence of new or recurrent clot.

Who gets Venous Thoracic Outlet Syndrome (besides elite swimmers)?

Although venous TOS is very uncommon, we do see it occur in a surprising number of young overhead athletes, not just elite swimmers like Jake, but also highly-ranked baseball pitchers, and volleyball players. Nobody yet knows why venous TOS occurs in these young and otherwise healthy individuals.

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What Causes Venous Thoracic Outlet Syndrome?

At present, the cause of blood clot formation in venous TOS remains somewhat mysterious. Most authorities agree that external compression of the vein must be present for blood clot to occur. However, imaging studies have shown that half of the normal population experiences external compression of the veins. The vast majority of these people do not develop blood clot or venous TOS. Therefore, there is an additional causative factor that leads to the blood clot, which remains uncertain at present.

Many experts suspect that the missing link resides in the lining of the blood vessels. This thin lining layer is known as the endothelium. The endothelium produces potent biologic chemicals that prevent blood from clotting on contact with the endothelium. Disturbance of this function may arise from the trauma of repeated compression, allowing formation of a blood clot.

Where can I learn more about Venous Thoracic Outlet Syndrome?

In a neat coincidence, it turns out that Jake’s father, James Marcum, MD, possesses significant expertise in studying the endothelium. Fortunately, Dr. Marcum shared his time and expertise with us on one of our live streaming events.

We also encourage our visitors to check out Dr. Marcum’s active YouTube video channel, where he presents many scientific and health topics in an inspired, well-informed, and easy to understand fashion.

We welcome you to visit the NeoVista® website to learn about the causes of venous thoracic outlet syndrome, diagnosis of venous thoracic outlet syndrome, and treatment of venous thoracic outlet syndrome.

Read more about thoracic outlet syndrome in athletes.

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