US demonstration of a thrombosed persistent median artery in carpal tunnel syndrome.

Median artery of the forearm and wrist is not very frequently observed because it normally involutes before birth. Only a few cases of persistent median artery thrombosis associated with compression of the median nerve in the carpal tunnel have been reported. In these cases symptoms arise suddenly and surgery consists of the excision of the thrombosed arterial branch. In cases of large persistent unthrombosed median artery associated with carpal tunnel syndrome (CTS), excision of the unthrombosed median artery is not indicated because it may sometimes substantially contribute to the circulation of the hand. We report the case of a 39-year-old man with CTS associated with a thrombosis of a persistent median artery detected by high-resolution US and Doppler ultrasound. US can be also useful to exclude other causes of CTS such as tenosynovitis of the flexor tendons, ganglion cyst, musculotendinous variants, and various soft tissue tumors.