Presentation
Disparity between interarm blood pressure measurement being higher on the right side.
Patient Data
Thoracic and abdominal aorta down to the common iliac: diffuse calcified atherosclerotic plaques (more noticeable at the arch and its main branches), no aneurysm, no dissection
The left subclavian artery shows segmental partially calcified eccentric posterior wall thickening at its origin causing luminal narrowing (the narrowed segment length measure 16 mm, the remaining lumen measure 2-2.5mm at its narrowest point, the estimated stenosis percentage of 75-80%), distally another calcified plaque is seen at the origin of the left vertebral artery causing no luminal narrowing
Carotid arteries are unremarkable apart from the calcified plaque at the proximal left ICA causing 40-45% stenosis
Case Discussion
Dedicated neck and upper limb ultrasound (not shown) shows a complete reversal of flow in the left vertebral artery with a tardus parvus waveform in the ipsilateral brachial artery as compared to the normal triphasic waveform on the right side indicating left sided subclavian steal phenomena as the patient has no neurologic complaint.
An inter-arm blood pressure difference is the systolic BP variation of more than 10 mmHg. This phenomenon has several causes such as subclavian artery stenosis, aortic aneurysm, aortic coarctation, vasculitis, fibromuscular hyperplasia, connective tissue disorders, and thoracic outlet compression, thus its detection necessitates further workup
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