PMC6708986_01
Clinical presentation. This figure shows the clinical presentation with discoloration of all fingers.
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A 28 year old professional female volleyball player complained of increasing arm and forearm pain for two weeks associated with unusual right digital cyanosis (Fig. 1).
Pre-operative magnetic resonance angiography. Transverse cross section of the right wrist showing intraluminal thrombus of both the ulnar and radial arteries (red arrows).
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Computed tomography angiography (CTA) in arm abduction and extension as well as magnetic resonance angiography (MRA) confirmed distal embolisation, but no aetiology could be found on these imaging modalities (Fig. 2).
Computed tomography angiography showing posterior circumflex humeral artery (3-D reconstructions).
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CTA was performed on day 7 in an attempt to find an aetiological factor. CTA in a neutral position revealed an 18mm diameter PCHA aneurysm (Fig. 3).
Per-operative view (A) Transaxillary approach identifying the posterior circumflex humeral artery aneurysm, which was dissected and ligated (B) Internal view showing intraluminal thrombus (white arrow).
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The axillary artery was exposed through an axillary approach to avoid harming the shoulder muscles, and the PCHA was identified and ligated (Fig. 4).