PMC9829695_01
Photograph shows right upper limb swelling.
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Distal pulses were intact, with normal capillary refill time and no pallor or cyanosis (Fig. 1).
Lateral right arm radiography showing hyperdense soft tissue swelling (star) separate from bone.
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Right upper arm radiography showed normal bones but a hyper-dense soft tissue swelling separate from the bone was evident anteriorly (Fig. 2) while ultrasound revealed 9 x 8.5 x 7.5 cm hypoechoic cystic mass with peripheral hypoechoic rim due to thrombus and a central turbulent flow.
A (left), B (right).. Colored Doppler ultrasonography (panel A) showing flow within the lesion (yin-yang sign) and "to-and fro" waveform on spectral Doppler ultrasonography (panel B). The "to" represents arterial blood going to PSA in systole, and "fro" is blood exiting in diastole.
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Colored Doppler ultrasonography flow within the lesion (yin-yang sign) and "to-and fro" waveform at spectral Doppler ultrasonography (Fig. 3A, B) were seen, findings which are diagnostic for PSA of the lower part of the right brachial artery.
A (left), B (right).. Sagittal MRI T1WI of the right arm (panel A) showing heterogeneous intensity mass (star) with peripheral organized thrombus (arrow-head) and miss-registration artifact (arrows), while phase contrast (PC) right brachial artery MRA with intravenous contrast (panel B) showing PSA of the lower part of right brachial artery with distinct contrast leak (star) into the PSA cavity.
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MRI disclosed the mass with heterogeneous intensity, peripheral organized thrombus, and miss-registration artifact (Fig. 4A) highly suggestive of PSA, while MRA with intra-venous contrast bring to light the PSA at the lower part of the right brachial artery with distinct contrast leak into the PSA cavity (Fig. 4B).