PMC6925774_01
Vascular arterial duplex of the right mid radial artery with pre-occlusive "thump" waveforms. Spectral waveforms with normal triphasic diastolic flow were noted in the subclavian, axillary, brachial and ulnar artery without significant color flow disturbance.
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fig1
Right upper extremity arterial Doppler ultrasound showed monophasic flow and was flat-line at the index finger and thumb with a preocclusive waveform in the mid radial artery and subsequent distal radial artery occlusion, as seen in Figure 1.
CT angiogram Chest with intravenous contrast shows small to moderate left lower lobe pulmonary emboli. A 2 cm pleural-based right lower lobe nodular density can also be seen. It should be noted that evaluation of the pulmonary arteries is suboptimal secondary to patient body habitus and under opacification of the pulmonary vessels.
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fig2
CTA of the chest and CTA of the abdomen were ordered and showed small to moderate, bilateral lower lobe, pulmonary emboli and a thrombus in the right external iliac artery as seen in Figures 2 and 3.
CT angiogram abdominal aorta with right lower extremity runoff shows a nonoccuslive longitudinal filling defect in the distal right external iliac artery and tibioperoneal trunk suggestive of a thrombus. There, however, are Patent common femoral artery, profunda, and SFA. Left lower extremity runoff showed a patent common femoral artery, profunda, popliteal artery and SFA. The abdominal aorta is widely patent and measures 2.3 cm the celiac, 2 cm at the SMA, and 1.7 cm below the renal arteries.
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fig3
CTA of the chest and CTA of the abdomen were ordered and showed small to moderate, bilateral lower lobe, pulmonary emboli and a thrombus in the right external iliac artery as seen in Figures 2 and 3.
CT angiogram abdominal aorta with right lower extremity runoff shows a globular filling defect at the mid and distal segment of the right SFA most consistent with an arterial embolus. The right profunda artery is grossly unremarkable. There is grossly adequate 3 vessel runoff. Left superficial femoral artery is grossly patent as well as popliteal artery with 3 vessels runoff. Both external iliac arteries are grossly patent. Both common femoral arteries are grossly patent.
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fig4
Repeated CTA of the abdomen with runoff showed a splenic infarct, and a filling defect at the mid and distal right superficial femoral artery, as seen in Figure 4, both consistent with underlying emboli.