42 yo male 2 weeks ago noticed discoloration involving his
left index finger. It was painful. He denies any trauma to
the area. He states his thumb had a similar episode one
month ago. Clinical examination reveals at left index finger
on the radial side, a purplish discoloration over his pulp.
On the ulnar side, he has a normal pink colouration and a
normal cap refill. His cap refill is the same for his other
digits. His Allen's test is normal. Vascular studies indicate
he has pulsatile flow in his left index finger, although it is
severely dampened. The same is true for his thumb,
though to a lesser degree. His long and ring finger also
demonstrate decreased flow though close to normal.
1. What is the most likely diagnosis?
2. What is the treatment?
1. What is the most likely diagnosis? The most
likely diagnosis is radial artery intimal hyperplasia at the level of the
EPL. (Look at the angiogram and follow the radial artery, behind
thumb metacarpal it is absent)
2. What is the treatment? Excision of the disease
segment