OCAD MSK

History

35F nurse 1.5 months numbness, tingling, weakness, carpal tunnel syndrome suspected

Figure 1 for case thrombus ( RID5037 ) — Figure 1

Figure 2 for case thrombus ( RID5037 ) — Figure 2

Figure 3 for case thrombus ( RID5037 ) — Figure 3

Figure 4 for case thrombus ( RID5037 ) — Figure 4

Figure 5 for case thrombus ( RID5037 ) — Figure 5

Discussion

Initial MRI (slide 1-2) show thrombosed persistent median artery (PMA), white arrow in MRI and follow up US. The median nerve (yellow arrow) is borderline thickened. Comparison of asymptomatic right wrist shows a normal variant Bifid median nerve and patent PMA. Telephone follow up reveals that she inexplicably received no treatment; the paresthesias resolved but she complains of cold fingers. Attached article reported 26% incidence PMA (20% uni, 6% bi lateral), 63% assocd with high bifid median nerve in carpal tunnel in 100 asymptomatic wrists. There have been 28 reports of thrombosed PMA, all rxd and resolved after anti coagulation. This case has taught me to look for and report PMA even in cases of non-Bifid median nerve, given the potential risk of injury with carpal tunnel release. Reference article.

Diagnosis

thrombus ( RID5037 )

Hilary Umans, MD

Courtesy

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