Match each patient's clinical presentation with the most likely underlying pathophysiologic diagnosis.
- A 24-year-old competitive runner presents with severe right calf cramping occurring exclusively during exertion. His ankle-brachial index is normal at rest but decreases significantly during active plantar flexion.Popliteal artery entrapment syndrome
- A 58-year-old man with a 30-pack-year smoking history reports worsening erectile dysfunction and cramping pain in both buttocks when walking short distances. Examination reveals symmetrically absent femoral pulses.Aortoiliac occlusive disease (Leriche syndrome)
- A 62-year-old woman develops episodic vertigo, blurred vision, and left arm aching specifically when she raises her left arm to arrange items on high shelves. Her left radial pulse is diminished compared to the right.Subclavian steal syndrome
- A 29-year-old professional baseball pitcher complains of right shoulder aching and forearm numbness that exacerbates during games. He demonstrates a loss of the radial pulse when his shoulder is abducted and externally rotated.Thoracic outlet syndrome
Answer
The correct matches pair exertional calf pain with plantar flexion to popliteal artery entrapment; buttock claudication with impotence to aortoiliac occlusive disease; arm exertion causing vertigo to subclavian steal syndrome; and positional overhead arm numbness to thoracic outlet syndrome.
Each clinical vignette provides highly specific diagnostic clues for distinct vascular pathologies. The young runner's symptoms are provoked mechanically by gastrocnemius contraction (popliteal artery entrapment). The older smoker's triad is pathognomonic for terminal aorta occlusion (Leriche syndrome). The older woman's arm exercise induces concurrent brainstem ischemia (subclavian steal). The pitcher's overhead positioning physically compresses the brachial plexus and subclavian artery (thoracic outlet syndrome).
Step-by-Step Solution
Key Concept
Vascular surgery presentations frequently rely on classic demographic, positional, and anatomic symptom constellations to identify the specific site and mechanism of arterial or neurovascular compromise.