Thrombosis of the Persistent Median Artery: A Sonographic Case Series

A bifid median nerve with a persistent median artery (PMA) is a frequently encountered radiological finding. Thrombosis of the PMA is a rare entity, but one seldom considered by assessing physicians owing to its infrequent occurrence. It remains a diagnosis of chance when patients present for routine imaging of the carpal tunnel with general symptoms such as pain or paresthesia. With a paucity of documented cases in the present literature, we provide a case series of 4 isolated instances of acute PMA thrombosis within a random patient cohort. A signature clinical and sonographic pattern present within our case series has not been clearly outlined in prior publications. All of our cases were observed within young, otherwise healthy individuals with localized volar wrist pain resembling carpal tunnel syndrome, a PMA located within the carpal tunnel (with coexisting bifid median nerve), and a thrombosed, enlarged, incompressible artery with absent flow on ultrasound.