Anatomy clinical correlates Quiz: Ace Your Exams

A 55-year-old man presents for follow-up evaluation after a recent myocardial infarction. The patient had a high-grade occlusion of the left anterior descending artery with stent placement. The patient has been compliant with medications. However, he has pain and weakness in the left upper extremity with exercise. The patient states, “I know something is not right. My arm turns ghost white every time I get on the treadmill, and I feel like I will pass out.” Past medical history includes hypertension, diabetes, and hyperlipidemia. Medications include aspirin, carvedilol, amlodipine, metformin, atorvastatin, and clopidogrel. He has a twenty-pack-year smoking history. Temperature is 37.0°C (98.6°F), pulse is 62/min, respirations are 14/min, and blood pressure is 140/70 mmHg in the right arm compared with 121/65 mmHg in the left arm. The left radial pulse demonstrates arrival delay compared to the right radial pulse. The patient's left hand presents a brisk capillary refill. The patient’s cardiologist subsequently orders an ultrasound of the heart and upper extremities. Which of the following findings is most likely to be found on ultrasonographic evaluation?