# A Case of Aortic Mural Thrombus Presenting as Recurrent Shoulder Pain Discovered by the Presence of Splinter Hemorrhages

## TL;DR

A patient with shoulder pain was found to have an aortic mural thrombus, showing how splinter hemorrhages and imaging can reveal rare vascular issues.

## Contribution

Highlights the importance of recognizing splinter hemorrhages and using vascular imaging for atypical upper-extremity pain.

## Key findings

- Splinter hemorrhages led to the discovery of a mural thrombus in the left subclavian artery.
- Anticoagulation improved symptoms, showing thrombus as a reversible cause of upper-extremity claudication.

## Abstract

Progressive claudication of the upper extremity is uncommon and can be misattributed to cervical radiculopathy or even shoulder pathology, such as tendonitis or bursitis. We report a patient presenting to the emergency department with several months of worsening left upper-extremity pain initially managed as suspected radiculopathy, but, in retrospect, was upper-extremity claudication. This was discovered through the presence of lesions beneath the fingernails of the left hand, splinter hemorrhages. A computed tomographic angiography (CTA) of the chest for aortic and vascular evaluation demonstrated a mural thrombus partially occluding the left subclavian artery. The patient was admitted for further management and observation. Following initiation of systemic anticoagulation, symptoms had significantly improved, and the patient was discharged home in stable condition. This case underscores the diagnostic importance of bedside examination and vascular imaging when evaluating atypical upper-extremity claudication. This also highlights arterial thrombus as a potentially reversible cause of upper-extremity pain when promptly recognized and treated.