Radiology Resident Case of the Week
Clinical Sx:
34 year old male smoker with ischemic fourth and fifth digits of the hand with possible diagnosis of Bergers disease.
Etiology/Pathophysiology
Hypothenar hammer syndrome results from repetitive blunt trauma to the palm of the hand. The position of the ulnar artery in the hypothenar eminence crossing the hamate bone makes it vulnerable to repetitive occupational or recreational trauma which may result in aneurysm formation or ulnar artery thrombosis, with the aneurysm occasionally serving as a source for digital emboli.
Pathology:
Miscellaneous
Imaging
The arterial lesion may appear angiographically as spasm, occulsion, aneurysm, or a combination. Arterial narrowing may result from arterial spasm, extrinsic compression, or subintimal hematoma. Intraluminal filling defects may represent intraluminal thrombosis or intimal flaps. Intimal flaps appear as thin lucent strips in the contrast column. Pseudoaneurysms are a focal widening of the lumen as a result of damage to the arterial media.
DDX
Emboli from different etiologies and atheroscerotic disease which can usually be differentiated by history.
Key references
AbramÕs Angiography, 4th Ed., Braum, Vol 2,1997, p1758.
Vascular Diseases, Surgical and Interventional Therapy, Strandness & Van Breda, Vol 1, 1994, p. 220, 221, 540.
ACR Code
914.732
Keywords: