An uncommon clinical presentation of acute limb ischemia: underscoring the role of perigenicular collaterals.

We present a case of atypical acute limb ischemia in a non-diabetic patient, with ankle-brachial pressure index of 0.6 and rest pain localized exclusively over the gastrocnemius muscle, sparing the foot. This uncommon presentation was attributed to an impaired perigenicular collateral network. Thrombolysis restored adequate perfusion only temporarily and was followed by thromboembolectomy. The ischemia presentation in our case underscores the importance of the adequacy of the perigeniculate collateral network for the perfusion of the tibial muscles and, especially, the gastrocnemius muscle.

A delayed diagnosis that altered the professional orientation of an athlete with upper limb chronic arterial embolization.

BACKGROUND: Vascular disorders of the upper extremity in young and physically active patients present a complex and challenging problem for the treating physician. Initial presentation may often be subtle and the consequences of misdiagnosis, delayed diagnosis or mistreatment can be severe. CASE REPORT: In this report, we discuss a case of a young woman with chronic upper limb ischemia due to an arterial thoracic outlet syndrome in whom even though symptoms persisted over a number of years during which she frequently sought medical consultation, remained undiagnosed until finally presenting with limb-threatening ischemia. Furthermore, due to this delay, the patient was forced to withdraw from her professional carrier in athletics. CONCLUSIONS: A thoughtful and through approach combining the history, physical findings, and use of appropriate diagnostic aids will provide the physician and patient with the greatest opportunity for a satisfactory outcome. Furthermore, a delay in definitive treatment may not only cause health deterioration, but may also incur social, economic and occupational consequences.