McCluskey Mia, Baber Peter, Rind Shahmir, Xu Dan
Curtin Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia.
Radiology Department, SKG Radiology, Murdoch, Western Australia, Australia.
BMJ Case Rep. 2023 Apr 25;16(4):e252966. doi: 10.1136/bcr-2022-252966.
A woman in her 70s presented to her general practitioner (GP) with a 3-month history of left upper arm pain and weakness. A significant difference in bilateral blood pressures was noted and a further history elicited coolness in her left arm without functional compromise. A CT angiography revealed variant subclavian steal syndrome with a subclavian arterial stenosis, which was proximal to both the internal mammary and thyrocervical trunk and her left vertebral artery originating from the aortic arch. She was referred to a vascular surgeon but declined surgical intervention. Her symptoms remain stable with 6-month follow-up from her GP. This case highlights the importance of considering vascular aetiologies in upper limb pain and weakness. Our case reviews the differential diagnoses of upper limb pain and weakness, consequently leading to the discussion of an interesting variant of subclavian stenosis.
一名70多岁的女性因左上臂疼痛和无力3个月就诊于她的全科医生（GP）。发现双侧血压存在显著差异，进一步询问病史得知她的左臂发凉但功能未受影响。CT血管造影显示为变异型锁骨下动脉盗血综合征，伴有锁骨下动脉狭窄，狭窄部位在胸廓内动脉和甲状颈干近端，且她的左椎动脉起源于主动脉弓。她被转诊给血管外科医生，但拒绝了手术干预。在全科医生6个月的随访中，她的症状保持稳定。该病例强调了在考虑上肢疼痛和无力的病因时血管因素的重要性。我们的病例回顾了上肢疼痛和无力的鉴别诊断，进而讨论了一种有趣的锁骨下狭窄变异型。
