Manar Khashram, Rajesh B Dharmaraj, Anantha Ramanathan, Tim Buckenham

A 39-year-old previously fit woman presented acutely to the emergency department with acute left upper limb ischaemia. On examination, the tips of the index and middle fingers were dusky. She had no palpable pulses and sensation was partially affected due to ischaemia. The motor function was normal and no nerve root signs were found (Rutherford IIa).

Palpation of the supraclavicular region revealed a smooth, hard protrusion resembling bone. The remaining vascular examination was unremarkable.

A right anterioposterior oblique cervical spine radiograph was performed (Figure 1).

Author information: Manar Khashram, Vascular Registrar1; Rajesh B Dharmaraj, Vascular Registrar1; Anantha Ramanathan, Consultant1; Tim Buckenham, Professor of Radiology2

Correspondence: Manar Khashram, Department of Vascular, Endovascular and Transplant Surgery, Private Bag 4710, Christchurch Hospital 8140, Christchurch, New Zealand. Email: manar.khashram@gmail.com