An 18 year old girl from south asia presents with intermittent pain of the right hand for 6 weeks. She was diagnosed with pulmonary tuberculosis 2 years ago, which was treated with a full course of therapy for 6 months. Followup for an year afterwards showed no evidence of recurrence. Her ESR is 120 mm/1h.
The tuberculin test is positive (11 mm induration).
The chest x-ray shows fibrosis of the apex of the left lung. There are no cavitations, fluffy shadows or effusions. There is no evidence of a cervical rib.
The temporal artery biopsy shows no evidence of vasculitis.
There is total occlusion of the right subclavian artery with a rich network of collaterals. There is significant stenosis of the left subclavian artery, from the origin to 3 cm distally. The aortic arch appears normal.