Reverse Flow Thromboembolism From Distal Subclavian Artery Aneurysm Due to Arterial Thoracic Outlet Syndrome and Posterior Circulation Stroke- Role of Dynamic Doppler Imaging.

INTRODUCTION: Arterial thoracic outlet syndrome (aTOS) is the least common among the 3 subtypes of thoracic outlet syndrome and can be the cause of posterior circulation infarction due to thrombus from a secondary thrombosed subclavian-axillary artery aneurysm. CASE REPORT: Here, we report a case of a 51-year-old man who presented to our institute with sudden onset vertigo, dizziness, vomiting, gait imbalance, and visual field defects immediately after strenuous exercise. Computed tomography angiography revealed bilateral cervical ribs with aneurysmal dilatation of the left distal subclavian and proximal axillary arteries. The computed tomography also revealed subacute infarcts in the bilateral cerebellar hemispheres, as well as in the bilateral occipital lobes. Color Doppler evaluation of the subclavian artery after hyperabduction of the ipsilateral arm revealed a continuous reversal of flow in the subclavian artery, which reached the vertebral ostia. The left cervical rib was resected, aneurysm was repaired, and the patient remained asymptomatic on follow-up. CONCLUSION: Posterior circulation stroke caused by the ipsilateral thrombosed subclavian artery aneurysm in an adult patient with aTOS due to a complete cervical rib is rare. A high index of suspicion should be present for thoracic outlet syndrome in patients with stroke and upper-limb arterial claudication symptoms. Dynamic Doppler evaluation in such patients can be used to demonstrate the underlying pathomechanism, and definitive surgical treatment can prevent further ischemic episodes. Posterior circulation stroke caused by partially thrombosed distal subclavian and axillary artery aneurysms due to aTOS is rare.

Synchronous Primary Multifocal Skeletal Chondrosarcoma of Extremity: A Report of 2 Cases.

CASE: Multifocal synchronous primary skeletal chondrosarcomas of an extremity are rarely reported. In this study, we report 2 such cases. The first case is a 32-year-old woman who presented with extensive right femoral and tibial diaphysis lesions. The second case is a 36-year-old woman with lesions in the left proximal humerus, the coracoid process of scapula and sternum. Both patients underwent limb salvage surgery and were disease-free at the 38- and 20-month follow-up. CONCLUSION: Athough rare, the possibility of multifocal chondrosarcoma should be kept in mind during the workup of a patient with chondrosarcoma.