The patient, a 17‐year‐old girl, presented to the emergency department with a 2‐week history of pain in her left arm and swelling of the fingers on her left hand. Her history was otherwise unremarkable. Notably, there were no symptoms of systemic inflammation (night sweats, fever, or weight loss). Clinical examination of the left arm revealed absence of pulses. Blood pressure was low (systolic 50 mm Hg) when measured on the left arm and elevated (170/100 mm Hg) when measured on the right arm. Physical examination revealed finger clubbing (Hippocratic fingers) only on the left hand. The C‐reactive protein level was mildly elevated (1.8 mg/dl [normal <0.5]). Color duplex sonography showed filiform long‐segment stenosis in the left common carotid artery (CCA) with marked concentric intimal thickening (arrow). This sonographic feature, known as macaroni sign, confirmed the diagnosis of Takayasu arteritis (TAK). Ultrasound and magnetic resonance angiography revealed an occlusion of the left subclavian and axillary artery (asterisk) as an underlying cause of finger clubbing on the left hand. Further imaging also revealed significant bilateral renal artery stenosis causing renovascular hypertension. Immunosuppressive and antihypertensive treatment was initiated. Subsequently, renal artery stenosis was treated with stent angioplasty. Bilateral clubbing can be seen in patients with severe cardiopulmonary disease, classically in patients with congenital cyanotic heart disease. Unilateral clubbing is a very rare presentation of TAK, resulting from severe chronic upper limb ischemia 1-3.

该患者为一名17岁女孩，因其左臂疼痛2周和左手手指肿胀而出现在急诊科。否则她的病史就不那么明显了。值得注意的是，没有全身性炎症症状（盗汗，发烧或体重减轻）。左臂的临床检查显示没有脉搏。左臂测量血压低（收缩压50 mm Hg），右臂测量血压升高（170/100 mm Hg）。体格检查仅在左手出现手指棍棒（希波克拉底手指）。C反应蛋白水平轻度升高（1.8 mg / dl [正常<0.5]）。彩色双工超声检查显示左颈总动脉（CCA）呈丝状长节段狭窄，同心内膜明显增厚（箭头）。这种被称为通心粉征的超声检查特征证实了高ak动脉炎（TAK）的诊断。超声和磁共振血管造影显示左锁骨下和腋动脉（星号）阻塞是左手手指杵状指的根本原因。进一步的影像学检查还显示出明显的双侧肾动脉狭窄引起肾血管性高血压。开始了免疫抑制和抗高血压治疗。随后，用支架血管成形术治疗肾动脉狭窄。在患有严重心肺疾病的患者中，典型地在患有先天性紫disease性心脏病的患者中，可以看到双边杵状指。单侧棍打是一种非常罕见的TAK表现，由严重的慢性上肢缺血1-3引起。