Right subclavian artery thrombosis due to cervical rib.

Figs. 4 and 5 : Thrombus in right subclavian artery Figs. 6 and 7 : Flow-void in axillary and radial arteries A 35 years female presented with severe pain of right hand and blackish discolouration of fingertips for last one month. She had no history of palpitation, dyspnoea, angina, fever, polyarthritis and fetal loss. She had past history of intermittent pain, claudication and raynaud’s phenomenon of same hand for last six months. Her blood pressure was 110/70 mm Hg in left hand. Pulse was not felt in right hand. All pulses in other extremities were felt normally. Pulse rate was 84/min, regular. temperature of right hand was lower than left. A firm structure was noted in right supraclavicular region. Right subclavian artery bruit was heard. Other systems were normal. Investigations revealed Hb 11 gm%, esr 32 mm/ hr, CrP arterial) are less common and present with or without neurologic symptoms. Arterial symptoms are usually due to cervical or first rib.1 Cervical rib leads to endothelial injury and intimal damage of subclavian artery that predispose to platelet deposition and thrombus formation. Intimal damage is also contributed by compressive forces exerted by shoulder girdle muscles during physical activity. Atherosclerotic changes and hypercoagulable states may contribute to thrombus formation. thrombus may cause embolisation to distal extremity. Cervical rib can also cause subclavian artery stenosis or aneurism. Acute subclavian artery thrombosis leads to a cold, painful, pulseless upper extremity. Chronic occlusion may lead to upper extremity claudication or it may remain asymptomatic due to collateral development. The condition may precipitate subclavian artery steal syndrome. Decompressive operations like anterior scalenectomy and excision of cervical or first rib, thrombectomy and arterial reconstruction are useful treatments of arterial TOS.2