Pulseless

An 18 year old girl from south asia presents with intermittent pain of the right hand for 6 weeks.

She was diagnosed with pulmonary tuberculosis 2 years ago, which was treated with a full course of therapy for 6 months. Followup for an year afterwards showed no evidence of recurrence.

Her ESR is 120 mm/1h.

Select Relevant Investigations
Tuberculin Test

Performed

The tuberculin test is positive (11 mm induration).
Chest X-Ray

Performed

The chest x-ray shows fibrosis of the apex of the left lung. There are no cavitations, fluffy shadows or effusions. There is no evidence of a cervical rib.
Temporal artery biopsy

Performed

The temporal artery biopsy shows no evidence of vasculitis.
CT Angiogram

Performed

There is total occlusion of the right subclavian artery with a rich network of collaterals. There is significant stenosis of the left subclavian artery, from the origin to 3 cm distally. The aortic arch appears normal.

Select Relevant Management
Antituberculous therapy
Steroids
Sympathectomy
Antibiotics