Medical Image of the Week: Vascular Occlusion
Wednesday, July 16, 2014 at 8:00AM 
Figure 1. Left arm angiogram showing complete occlusion of ulnar artery (red arrow).
Figure 2. Angiogram showing left radial artery complete occlusion (red arrow).
Figure 3. Left hand with necrotic fingers.
The patient is a 39 year-old woman with no significant past medical history presenting with progressive left hand pain for five days. The patient denied a history of Raynaud’s phenomenon or clotting disorders. She had no radial pulse on presentation and angiogram showed severe complete occlusion of the radial and ulnar arteries (Figures 1 and 2). She had an initial partial response with intra-arterial verapamil and nitroglycerin but her hand ischemia did not improve on heparin or with intra-arterial tissue plasminogen activator. Autoimmune and coagulation work-ups were negative. Her left hand finger necrosis at time of discharge is shown (Figure 3). Further evaluation is ongoing for coagulation disorders.
Allison Shapiro MD, Carmen Luraschi-Monjagatta MD, Matthew Schreiber MD.
Department of Internal Medicine, Pulmonary and Critical Care, University of Nevada School of Medicine, Las Vegas, NV
Reference as: Shapiro A, Luraschi-Mongagatta C, Schreiber M. Medical image of the week: vascular occlusion. Southwest J Pulm Crit Care. 2014;9(1):36-7. doi: http://dx.doi.org/10.13175/swjpcc093-14 PDF
Reader Comments (1)
Whoa, that's really cool. It looks gross on the outside, but definitely hard to tell what is going to happen. I wonder the best to way solve this. So unique.