MRA Upper Extremity (Magnetic Resonance Angiogram)

1 Major Symptom or Complaint presented as primary indication

1.1 Aching pain in extremity, relieved by rest

• 1.1.1 Suspected Peripheral Arterial Disease

1.2 Asymmetric pulses

• 1.2.1 Suspected Peripheral Arterial Disease

1.3 Bleeding

• 1.3.1 Suspected AVM

1.4 Claudication

1.5 Localized skin discoloration

• 1.5.1 Suspected AVM

1.6 Pain

• 1.6.1 Suspected AVM

1.7 Pulsatile mass

• 1.7.1 Suspected AVM

1.8 Ulceration

• 1.8.1 Suspected AVM

2 Working Diagnosis or Rule Out presented as primary indication

2.1 AVM Arteriovenous Malformation Suspected

• 2.1.1 Bleeding
• 2.1.2 Localized skin discoloration
• 2.1.3 Pain
• 2.1.4 Palpable subcutaneous thrill
• 2.1.5 Ulceration

References:

• White, Robert I., Jr, Pollak, Jeffrey, Persing, John, Henderson, Katharine J., Thomson, J. Grant, Burdge, Catherine M. Long-Term Outcome of Embolotherapy and Surgery for High-Flow Extremity Arteriovenous Malformations J Vasc Interv Radiol 2000 11: 1285-1295
• Schwartz’s Principles of Surgery, 8th Edition F. Charles Brunicardi, et al Copyright © 2005, The McGraw-Hill Companies, Inc.Chapter 15. Skin and Subcutaneous Tissue Scott L. Hansen, Stephen J. Mathes, David M. Young

2.2 Peripheral Arterial Disease Suspected ONE Risk Factor or Symptom

2.2.1 Risk Factors

• 2.2.1.1 Diabetes
• 2.2.1.2 Hypercholesterolemia
• 2.2.1.3 Smoker

2.2.2 Symptoms or Findings

• 2.2.2.1 Aching Pain in extremity relieved by rest
• 2.2.2.2 Asymmetric Blood Pressure in Arms
• 2.2.2.3 Asymmetric Pulses
• 2.2.2.4 Bruit
• 2.2.2.5 Palpable Arterial Thrill
• 2.2.2.6 Positive or Suspicious Doppler exam

References

• Hurst’s The Heart 11th Edition Valentin Fuster, R. Wayne Alexander, and Robert A. O’Rourke, Eds.; Copyright ©2006 The McGraw-Hill Companies. Chapterr 101. Diagnosis and Management of Diseases of the Peripheral Arteries and Veins Paul W. Wennberg, Thom W. Rooke Emile R. Mohler, III; Peripheral Arterial Disease: Identification and Implications; Arch Intern Med 2003 163: 2306-2314

3 Abnormal Physical Exam Finding presented as primary indication

3.1 Absent or diminished peripheral pulses

• 3.1.1 Suspected Peripheral Arterial Disease

3.2 Arterial bruit

• 3.2.1 Suspected Peripheral Arterial Disease

3.3 Asymmetric blood pressure

• 3.3.1 Suspected Peripheral Arterial Disease

3.4 Asymmetric pulses

• 3.4.1 Suspected Peripheral Arterial Disease

3.5 Localized skin discoloration

• 3.5.1 Suspected AVM

3.6 Palpable subcutaneous thrill

• 3.6.1 Suspected AVM

3.7 Pulsatile mass

• 3.7.1 Suspected AVM

3.8 Ulceration

• 3.8.1 Suspected AVM

4 Abnormal Lab or Imaging presented as primary indication

5 Significant Prior Medical History presented as primary indication

5.1 Trauma, vascular injury suspected

5.2 Aneurysm, known, interval follow up

• 5.2.1 Asymptomatic, no more than twice per year
• 5.2.2 Any change in physical findings

5.3 Known Peripheral Arerial Disease

• 5.3.1 Assessment prior to planned surgery
• 5.3.2 New or worsening symptoms

References

• G H Roditi, and G Harold Magnetic resonance angiography and computed tomography angiography for peripheral arterial disease Imaging 16: 205-229,