- A 64-year old woman presented to the emergency department with a 6-month history of right lateral cervical pain and a 2-week history of erythema and swelling of her right hand and wrist, accompanied by a tingling sensation alongher right forearm. The patient denied recent occurrence of fever, recent trauma, or strenuous exercise. She appeared comfortable. Her temperature was 36.2 °C, blood pressure was 132/ 70mmHg, pulsewas 89 beats/minute andO2 saturationwas 98% in ambient room air. Physical examination of the right upper limb revealed mild erythema and non-pitting edema of the hand and wrist as well as decreased sensation to light touch and pain along the C8–T1 dermatomes. Motor strength in all muscle groups and deep tendon reflexes remained intact. Loss of the radial pulse during inspiration was noted upon ipsilateral rotation of the head during neck extension. Examination of the rest of the neck, left arm and lower limbs was normal. Laboratory work-up including complete blood count, erythrocyte sedimentation rate, and C-reactive protein was within the normal limits. A posterior–anterior chest roentgenogram was obtained (Fig. 1).