A Never Described Variant of the Cervical Rib Causing Arterial Thoracic Outlet Syndrome: World's First Case.

Cervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.

An Interesting Case of a Cold Left Arm.

Inter-arm variability in blood pressure readings typically signifies arterial disease between the aortic arch and the subclavian artery. The differential diagnosis includes thoracic aortic dissection, atherosclerosis, thoracic outlet syndrome, and subclavian artery stenosis and thrombosis. In patients with prior coronary artery bypass grafting, including the internal mammary artery, several of those conditions can compromise coronary blood flow and lead to myocardial ischemia. Here we discuss a case of left subclavian artery thrombosis, which compromised left internal mammary artery blood flow and led to ischemic ventricular tachycardia.

Reconstruction of complex shoulder defect in a case of subclavian artery thrombosis.

We report a case of a 24-year-old man with complex shoulder defect on the right side following a road traffic accident. The patient was found to have a subclavian artery thrombosis in its second part with good collaterals ensuring limb viability. Free-flap reconstruction was not possible because of lack of recipient vascular pedicle nearby. Pedicled flaps routinely used for this area such as pectoralis major and latissimus dorsi myocutaneous flaps could not be used as their vascular pedicles arise from the second and third parts of the axillary artery distal to the subclavian artery thrombosis. The best option we could think was the trapezius myocutaneous flap as its vascular pedicle arises from the first part of the subclavian artery proximal to the thrombosis. This article further establishes the importance of knowing the vascular supply of flaps before their clinical application. In this case the trapezius flap acts as a lifeboat for coverage of the complex shoulder defect as its vascular supply is proximal to the site of subclavian artery thrombosis.