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Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition
  1. Raja Lahiri1,
  2. Udit Chauhan2,
  3. Ajay Kumar3 and
  4. Nisanth Puliyath4
  1. 1CVTS, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
  2. 2Intervention Radiology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
  3. 3Cardiac Anaesthesia, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
  4. 4General Surgery, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
  1. Correspondence to Dr Raja Lahiri; rajalahiri.imsbhu{at}


Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.

  • vascular surgery
  • cardiothoracic surgery
  • cardiovascular system

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  • Contributors RL was responsible for drafting the manuscript. He was the primary surgeon. UC was responsible for the diagnostic imaging and for approval of the final version of the manuscript. AK was responsible for the intraoperative anaesthetic support as well as approval of the final version of the manuscript. NP was responsible for data collection, compilation and approval of the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.