Left-right difference in pulse of upper extremity

Aortic dissection is a condition in which blood enters the tunica media due to rupture of the intima, tunica media, or adventitia that make up the aorta. In the acute phase, there are complications such as thinning of the wall of the dissected vessel, which may lead to rupture; organ ischemia due to blockage of blood flow to major organs by the dissection; and cardiac tamponade, in which blood accumulates around the heart. Cerebral ischemia occurs in 3-7% of cases, and upper extremity ischemia in 2-15%. In most cases, ischemia occurs suddenly and without warning, with severe pain in the chest or back.

A longtime acquaintance and friend of mine since high school, a practicing physician, had sudden back pain after dinner on the evening of January 2. He thought this was an orthopedic ailment and contacted an orthopedic surgeon he knew to see him. The doctor noticed a left to right difference in the pulse in my friend’s wrist and immediately determined that this was upper extremity ischemia from aortic dissection. Excellent diagnostic skills. He immediately called the cardiac surgeon at the nearby General Medical Center, who performed emergency surgery in the middle of the night, saving my friend’s life. It was a brilliant collaboration.

 Without the accurate and prompt initial diagnosis by the orthopedic surgeon, he would have been in serious trouble. My friend was lucky.