Clinical Presentation

A 35-year-old man presents to the emergency department with an abrupt onset of pain and pallor in the left arm.

(A) Infused computed tomographic (CT) scan shows filling defect within the proximal portion of the left subclavianartery (arrow). (B) Angiogram of the aortic arch shows subclavian artery filling defect proximal to the takeoff of the ver tebral artery (arrow). (C,D) Three-dimensional volume-rendered and maximal-intensity-projection images from a computed tomographic angiogram (CTA) of the left arm show abrupt occlusion of the forearm trifurcation arteries, indicating distal thromboembolism (arrows). Surgical clips indicate attempted surgical revascularization.

Differential Diagnosis

• Subclavian artery thrombosis with distal thromboembolism: Indicated by the symptoms, the acute presentation, and the imaging findings of an acute arterial filling defect and distal abrupt occlusions.