James D. Collins, MD

The patient is a 48-year-old male with "heart trouble" since the age of 6 years, after having rheumatic fever. He was treated with digitalis and diuretics until he was 31 years of age when he was admitted for heart failure and underwent closed commissurotomy.

A radiograph to detect the presence of a cervical rib should be mandatory prior to thoracic outlet syndrome surgery as a baseline study.

When a patient's presenting complaint is chest pain, consider plain radiographs directed to the area of pain and do not forget to look at the bones.

Since pain typically presents before bone lesions are displayed on radiographs, a true diagnosis may be overlooked and the early stages can be easily missed.