RT Book, Section A1 Shakhnovich, Irina A2 Dean, Steven M. A2 Satiani, Bhagwan A2 Abraham, William T. SR Print(0) ID 1105289837 T1 THORACIC OUTLET SYNDROME AND ARTERIAL ANEURYSM OF UPPER EXTREMITY T2 Color Atlas and Synopsis of Vascular Diseases YR 2015 FD 2015 PB McGraw-Hill Medical PP New York, NY SN 9780071749541 LK accesssurgery.mhmedical.com/content.aspx?aid=1105289837 RD 2024/10/14 AB A 20-year-old woman presented to the emergency room with sudden onset of cold, pale fingers, and discolored spots in the fingertips of the left hand (Figure 13-1). The patient's medical history was significant for fatigue and weakness of the left hand for about 1 year. She attributed these symptoms to overuse at work as a nursing assistant at the hospital. Her physical examination was significant for discoloration and splinter hemorrhages of the fingers. She had palpable radial and ulnar pulses. With overhead left arm elevation, the patient complained of pain in the entire left upper extremity. The workup included a chest x-ray and left upper extremity angiogram. The chest x-ray showed bilateral cervical ribs (Figure 13-2). Angiogram confirmed the presence of a subclavian artery aneurysm with partial thrombosis (Figure 13-3). Her hand angiogram showed evidence of embolic disease to her digits (Figure 13-4).