Point-of-care ultrasonography in the diagnosis of subclavian steal syndrome

• Published in: BMJ case reports Vol. 16; no. 4; p. e254477
• Main Authors: Uematsu, Haruhiro, Noguchi, Yoshinori, Osugi, Yasuhiro
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 07.04.2023
• Subjects: Asymptomatic; Blood pressure; Case reports; Humans; Ischemia; Medical diagnosis; Medical imaging; Point of care testing; Point-of-Care Systems; Primary care; Subclavian Artery - diagnostic imaging; Subclavian Steal Syndrome - diagnostic imaging; Ultrasonic imaging; Ultrasonography; Veins & arteries; General practice / family medicine; Ultrasonography
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2022-254477

Correspondence to Dr Haruhiro Uematsu; HIRO_UEMATSU@hotmail.com Description A male patient in his early 70s with a history of vasospastic angina reported a discrepancy in blood pressure (BP) between his arms during a routine visit at a primary care office. Subclavian steal syndrome is defined as a vascular phenomenon when proximal subclavian stenosis results in retrograde flow of the vertebral artery.1 Most of these patients are asymptomatic, but when symptoms occur, they include neurological symptoms due to the posterior cerebral circulation, upper extremity ischaemia, and rarely, cardiac ischaemia.2 Clinically, a pulse deficit or BP difference ≥20 mm Hg between the arms along with imaging tests is required to confirm a diagnosis.3 Non-invasive imaging modalities, such as carotid duplex ultrasound, CT angiography and MR angiography, can be selectively used for diagnosis.4 However, those modalities have a high threshold for primary care settings regarding the cost, accessibility or the operator’s experience. POCUS by a primary care physician appears to be helpful in narrowing the differential diagnosis of the BP discrepancy between arms, adequately controlling diagnostic imaging resources, increasing the patient’s satisfaction and augmenting the physician’s confidence.