CT Angiogram - Hypoplastic Vertebral, Subclavian

• 1. Dr Jishanth M Prof P Chitrambalams Unit Stanley Medical College

2.

• 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

3.

• 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

4.

• 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 orsensory deficit

• • • No meningeal signs

• • • Fundus - normal

5.

• Hb 11.4 g%

• TC7500

• DCP69L28E3

• ESR 6/14 mm

• Platelets 1.2 L

• RFT normal

• ECG normal

• CXRnormal

• X ray cervical spine normal

• CT Brain- normal study

• USG Abdomen normal study

6. 7. 8.

• 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

9. 10. 11. 12. 13. 14. 15.

• 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 theproximal left axillary arterywith suspicious thickening of its wall.

• Distal axillary artery is reformedthrough chest wall collaterals.

• Brachial artery appears normal with normal radial and ulnar arteries.

• Superficial and deep palmar arch formed normally.

16.