Discrepancy in blood pressure between the left and right arms - importance of clinical diagnosis and role of radiological imaging
- Author:
Pei Xuan Kuan
;
Pui Wen Tan
;
Ahmad Tirmizi Jobli
;
Norsila Abd Razak
- Publication Type:Case Reports
- Keywords:
Aortic dissection;
Blood pressure discrepancy;
Clinical judgement;
Diagnostic imaging
- MeSH:
Blood Pressure
- From:
The Medical Journal of Malaysia
2016;71(4):206-208
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Differences in systolic blood pressure reading
between arms are common but could signal trouble if the
discrepancy is significant. Early detection of aortic
dissection could invariably determine patient’s survivability.
Hence, a high index of suspicion with prompt diagnostic
imaging is vital for accurate diagnosis. Case Presentation: A
previously healthy 35-year-old lady was referred from
district hospital for hypertensive cardiomyopathy
complicated by acute pulmonary oedema. After being
admitted to the Intensive Care Unit, the mean arterial
pressure on the left arm was noted to be significant higher.
On physical examination, both lower limbs were dusky in
appearance because of poor perfusion. Investigations:
Computed Tomography Angiography showed extensive
arch and abdominal aorta dissection extending to the
proximal common carotid artery. There was distal abdominal
aorta thrombosis with partial left renal infarction.
Echocardiogram showed global hypokinesia, presence of
intimal flap, aortic regurgitation and mild pericardial
effusion. Supine chest X-ray showed apparent
cardiomegaly. Treatment: Repair of the ascending aortic
dissection and suspension of the aortic valve by the
cardiothoracic team on Day 2 of admission. The vascular
team did bilateral high above knee amputation on Day 9 of
admission. Outcome: Patient passed away on Day 10 of
admission. Discussion: With the absence of classical
features of aortic dissection, establishing the diagnosis can
be challenging and requires both good clinical judgment
and prompt radiological imaging, such that early treatment
can be initiated. Conclusion: A high index of suspicion and
good clinical judgment is needed in cases of significant
blood pressure discrepancy between arms.
- Full text:P020161107414808300891.pdf
