Which clinical finding is most suggestive of an acute arterial thrombosis?

Which clinical finding is most suggestive of an acute arterial thrombosis?

• A. Gradual onset of mild pain with palpable pulses
• B. Intermittent claudication with normal pulses
• C. Acute onset of severe pain with no pulses
• D. Pain with paresthesias but palpable pulses

Answer: (C)

Acute arterial thrombosis presents as sudden, severe limb ischemia with abrupt loss of distal pulses. The defining clue is the quick onset of intense pain paired with no detectable pulses in the affected extremity, reflecting abrupt arterial occlusion and compromised blood flow. This is a surgical emergency because prolonged ischemia can lead to tissue death. By contrast, gradual mild pain with palpable pulses points to chronic peripheral artery disease; intermittent claudication with normal pulses indicates exertional pain with adequate perfusion at rest; pain with paresthesias but preserved pulses can be neuropathic or represent early ischemia without complete occlusion. The presence of suddenly absent pulses makes the acute thrombotic process the best explanation.

Acute arterial thrombosis presents as sudden, severe limb ischemia with abrupt loss of distal pulses. The defining clue is the quick onset of intense pain paired with no detectable pulses in the affected extremity, reflecting abrupt arterial occlusion and compromised blood flow. This is a surgical emergency because prolonged ischemia can lead to tissue death. By contrast, gradual mild pain with palpable pulses points to chronic peripheral artery disease; intermittent claudication with normal pulses indicates exertional pain with adequate perfusion at rest; pain with paresthesias but preserved pulses can be neuropathic or represent early ischemia without complete occlusion. The presence of suddenly absent pulses makes the acute thrombotic process the best explanation.