Clinical Presentation

A 41-year old man presents with “cold” fingers.

(A) Earlier image from an angiogram of the right hand shows filling of the superficial (large arrow) and deep (arrowhead) palmar arches by a patent radial artery, but nonvisualization of the ulnar artery (small arrow). (B) Later image shows nonvisualization of the ulnar artery (arrow) and the ulnar digital artery of the fifth digit (small arrowhead), as well as abrupt cutoff of a palmar digital artery (large arrowhead). The abnormalities were refractory to intra-arterial nitroglycerin.

Differential Diagnosis