Blood Pressure Difference of more than 100 mmHg between Arms caused by Stenosis of the Brachiocephalic Trunk

A 78-year-old woman with hypertension and diabetes mellitus was admitted to the Department of Internal Medicine with fatigue. There was a profound difference in blood pressure between her right (116/97 mmHg) and left arms (231/126 mmHg). The patient’s physical examination was otherwise unremarkable. A difference of 10 mmHg or higher, or of 15 mmHg or more, between arms can identify patients at a high risk of asymptomatic peripheral vascular disease and mortality who may benefit from further assessment [1]. Therefore, the patient underwent three-dimensional computed tomography (3D CT) and arch aortography to detect the presence of narrowing or hardening of the arteries. 3D CT revealed severe brachiocephalic trunk calcification (Panel A-C), and on contrast examination, 99% stenosis was observed in the brachiocephalic trunk, which was determined to be the cause of the blood pressure difference (Panel D).