MISDIAGNOSIS OF CERVICOBRACHIAL SYNDROME WITH SUBOCCLUSION OF THE LEFT SUBCLAVIAN ARTERY

Authors

  • Antonio Georgiev University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Robert Nikolovski University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Oliver Kalpak University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Hristo Pejkov University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Marjan Boshev University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Mario Jovanoski University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Ivica Bojovski University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Nikola Manev University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Goran Mitevski University Clinic for Cardiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Marija Jovanovski Srceva University Clinics for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation, and Intensive Care Medicine and Emergency Department, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Daniela Georgieva University Clinic for Orthopedic Disease, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Roza Dzoleva-Tolevska University Clinic for Orthopedic Disease, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

Keywords:

cervicobrachial syndrome, subclavian subocclusion, diagnosis, treatment

Abstract

Introduction: Cervical spondylosis (degenerative osteoarthritis) and subclavian occlusion, mostly caused by atherosclerosis, share similar symptoms. Both are diseases of the advanced age. Thus, there are similarities of overlapping or misdiagnosis of both diseases.

The aim of this case report was to present diagnosis and treatment of subclavian subocclusion and possibility of misdiagnosis with cervicobrachial syndrome.

Case report: We present the case of a 71-year-old woman with noncontrolled hypertension. For many years she complained of occasional pains and tingling in her neck, left shoulder, and hand, coolness in the fingers of the left hand, headache and occasionally dizziness. An x-ray finding of the cervical spine was in favor of spondyloarthrosis on the neck vertebrae, and after consulting an orthopedic specialist, she was diagnosed and treated as cervicobrachial syndrome for many years without success. Cardiology examination detected different high blood pressure readings in both arms and that induced us to perform a computerized angiography (CT). CT showed subocclusion on the left subclavian artery after which our patient underwent angiography and stent implantation. After the procedure, the blood pressure difference decreased and the symptoms disappeared.

Conclusion: Due to similar symptoms, whenever cervicobrachial syndrome is diagnosed, the blood pressures in both arms should be measured. In case of their difference, subclavian stenosis should also be considered and appropriate investigations should be made, especially if the difference in pressures is high.

References

Mayuri Zoting, Shivani Uttamchandani, Mitushi Deshmukh, Om C. Wadhokar. A Case Report of Silent Cervical Spondylosis with Neck Pain. Journal of Pharmaceutical Research International 2021; 33(48A): 232-237. doi:10.9734/jpri/2021/v33i48A33244.

Mubarik A, Iqbal AM. Subclavian Artery Thrombosis. StatPearls Publishing 2022. PMID: 30725960. Bookshelf ID: NBK537275.

Caesar-Peterson S, Bishop MA, Qaja E. Subclavian Artery Stenosis. StatPearls Publishing 2022. Jas go naogjam samo 2023. PMID: 29261913. Bookshelf ID: NBK470221.

Sira Duson, and Seyed-Mojtaba Gashti. A Look at Proximal Subclavian Artery Occlusive Disease. Endovascular Today 2012; 28-32.

Khoury SR, Ratchford EV. Vascular Disease Patient Information Page: Subclavian artery stenosis. Vascular Medicine 2021; 26(4): 464-468. doi: 10.1177/1358863X211021160.

Potter BJ, Pinto DS. Subclavian Steal Syndrome. Circulation 2014; 129(22): 2320-2323. doi: 10.1161/CIRCULATIONAHA.113.006653.

George JC. Endovascular Treatment of a Complex Chronic Total Occlusion of Left Subclavian Artery in a Patient with Coronary-Subclavian Steal Syndrome. Vascular disease management 2012; 9(3): E39-E41.

Gatto LAM, Seabra DMR, Zenatti GAG, Frose L, Koppe GL, Demartini Z. Endovascular Treatment in the Subclavian Steal Syndrome: Series of 29 Patients. ArquivosBrasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(02): e120-e124. doi: 10.1055/s-0040-1719000.

Kirch W, Schafii C. Misdiagnosis at a university hospital in 4 medical eras. Medicine 1996; 75(1): 29-40. doi: 10.1097/00005792-199601000-00004.

Horta M, Fernandes O, Costa N, Leal C, Figueiredo L. Left subclavian artery occlusion: a cause of subclavian steal syndrome. Eurorad 2014. doi: 10.1594/EURORAD/CASE.11671.

Yamamoto N, Dejima A, Hasatani K. Discrepancy of blood pressure between arms: a case of left subclavian artery occlusion. BMJ Case Reports 2021; 14(4): e242025. doi: 10.1136/bcr-2021-242025.

Liu Y, Zhang J, Gu Y, Guo L, Li J. Clinical Effectiveness of Endovascular Therapy for Total Occlusion of the Subclavian Arteries: A Study of 67 Patients. Annals of Vascular Surgery 2016; 35: 189-196. doi: https://doi.org/10.1016/j.avsg.2016.01.051.

Guochen Niu, Ziguang Yan, Bihui Zhang and Min Yang. Endovascular Treatment of Chronic Total Occlusion in the Subclavian Artery: A Review of 23 Cases. Front Neurol 2020; 11: 264. doi: 10.3389/fneur.2020.00264.

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Published

2023-12-27

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Section

Case Reports