Thursday, September 29, 2016

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This CT scan is from a young woman with a pulsatile supraclavicular mass on the left side. She also gets pain with exertion in that arm. Sometimes, she gets pallor, paresthesias, and coldness in her left hand, and she was initially diagnosed with Raynaud's but wants a second opinion. There is no history of trauma. She has no other medical problems. Her pulses on that arm are diminished. There is no musculoskeletal tenderness.

Challenge: This is the least common version of what syndrome?

Image shown under Fair Use.


Anonymous said...

Takayasu arteritis causing an aneurysm resulting in a palpable neck mass and signs of arterial occlusion with the decrease pulses, and claudication?

Craig Chen said...

nice guess - definitely on the differential, and also a great disease for case of the day
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This is a thoracic outlet syndrome, the constellation of signs and symptoms arising from compression of the neurovascular bundle just above the first rib and behind the clavicle. In this case, the subclavian artery is compressed by an oblique band of tissue (arrow). The arrowhead shows post-stenotic diltation of the artery.

Source: UpToDate.