Volume 50, Issue 2 Summer 2026 JVU 502-101 | Thrombosis of the Persistent Median Artery: A Sonographic Case Series-Thrombosis

Thrombosis

Pdf Summary

This case series describes four young, otherwise healthy patients with acute thrombosis of a persistent median artery (PMA) in the carpal tunnel, diagnosed by ultrasound or MRI. The PMA commonly coexisted with a bifid median nerve, an anatomical variant already known to be associated with carpal tunnel syndrome (CTS).  <br /><br />Patients presented with atypical volar wrist or forearm pain, paresthesia, or CTS-like symptoms, but not with classic signs of arterial ischemia such as pallor, cool digits, or pulse loss. Imaging consistently showed an enlarged, incompressible PMA containing hypoechoic or heterogeneous thrombus and absent Doppler flow. Some cases also showed secondary median neuropathy, including nerve thickening, fascicular edema, or perineural cuffing.  <br /><br />The authors emphasize that PMA thrombosis is rare and often overlooked, but it can mimic CTS and should be considered when evaluating wrist pain, especially in patients with a bifid median nerve. The carpal tunnel’s confined space and the shared sheath between the PMA and median nerve may contribute to mechanical irritation, crowding, and thrombosis.  <br /><br />Treatment in the reported cases included anticoagulation, with limited recanalization on follow-up in some patients. Surgical excision with carpal tunnel release is also described as a possible option in the literature.  <br /><br />Overall, the paper identifies a recognizable clinical and sonographic pattern for PMA thrombosis: young patient, focal volar wrist pain or CTS-like symptoms, bifid median nerve, thrombosed enlarged PMA, and absent Doppler flow. Recognizing this pattern may help clinicians avoid misdiagnosis and guide earlier management.

Keywords

persistent median artery

thrombosis

carpal tunnel syndrome

bifid median nerve

ultrasound

MRI

volar wrist pain

median neuropathy

absent Doppler flow

anticoagulation