Dr Jishanth MProf P Chitrambalam’s Unit
Stanley Medical College
Mrs Jaya, 32 yrs/F Admitted for pain suggestive of claudication of left
upper limb – 2years Episodic head ache -2 weeks
Past history of monoparesis of left upper limb 10 years back
Married 13 yrs back, one child, h/o induced abortion 2 yrs back
Conscious , oriented No facial asymmetry No asymmetry of limbs No pallor, jaundice,
cyanosis PULSE:• Rate- 84/ min• Regular, normal in volume
and character• Absent on left UL( both
radial and brachial pulses absent)
• Other peripheral pulses normal
BLOOD PRESSURE R UL 120/80 L UL – not recordable R LL 140/90 L LL 140/90
CVS s1, s2 normal ,No murmers Subclavian bruit + on Left side No carotid bruit
RS - normal
Abdomen- No renal bruit, no femoral bruit
Nervous System examn.. Higher functions normal, Cranial nerves intact. No motor or sensory deficit No meningeal signs Fundus - normal
Hb 11.4 g%TC 7500DC P69L28E3ESR 6/14 mmPlatelets 1.2 LRFT normalECG normalCXR normalX ray cervical spine – normalCT Brain- normal studyUSG Abdomen – normal study
Cardiac evaluation was normal Echo was normal with normal LV systolic
function No evidence of great vessel disease
Suggested CT angiogram Ophthalmology evaluation normal ENT opinion CT PNS- mild DNS to left, bilateral
maxillary, ethmoidal and sphenoidal sinusitis
Hypoplastic left vertebral artery Right upperlimb vessels normal Left subclavian artery appears
hypoplastic from its origin( 3mm in diameters)
Thin stream of contrast noted in the proximal left axillary artery with suspicious thickening of its wall.
Distal axillary artery is reformed through chest wall collaterals.
Brachial artery appears normal with normal radial and ulnar arteries.
Superficial and deep palmar arch formed normally.
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