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| IMAGE QUIZ ARCHIVE | ||||||
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Image Quiz Digital Ischemia of an Index Finger1 | ||||||||||
 Figure 1 For larger view place cursor on image | A fifty-five-year-old healthy woman who worked at a restaurant was referred because of a twenty-four-hour history of pain, numbness, and bluish discoloration of the left index finger. Clinical examination revealed an absent radial pulse and a positive Allen test, denoting inadequate inflow through the radial artery. For the Allen test, the patient performed repeated, forceful flexion and extension of the digit while the examiner applied pressure to the volar radial and ulnar arteries at the wrist with his thumbs and pressed on the dorsal aspect of the wrist with his forefingers. When the pressure over the radial artery was released, the hand remained white and ischemic, indicating no perfusion through that artery. Sensation in the index finger was diminished, with two-point discrimination of greater than twenty millimeters. Notably, the radial pulse was not palpable at the wrist on the contralateral, asymptomatic side. An arteriogram of the affected hand is shown (Figure 1). | |||||||||
 Figure 2 For larger view place cursor on image | Local intra-arterial infusion of urokinase (100,000 units per hour) was begun, and repeat angiography, twenty-four hours later, demonstrated restoration of blood flow to the affected digit (Figure 2). | |||||||||
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What is the diagnosis? | ||||||||||
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