Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 5 2026 05 03 199 202 Elmar Bayraktarov Department of Radiology, Diakonie Klinikum Kirchen, Kirchen, Germany. 2025 10 29 2025 12 29 A 57-year-old female patient presented with acute onset of pain and bluish discoloration of the right hand. Physical examination revealed a cold, cyanotic right hand with absent radial, ulnar, and brachial pulses. Laboratory evaluation showed no pathological abnormalities, and there was no history of chronic disease or recent surgical intervention. Urgent CT angiography of the thorax and upper extremity demonstrated an aberrant right subclavian artery consistent with Adachi and Williams Classification Type G, with complete luminal occlusion caused by a 25-mm thrombus. Additional thrombotic occlusion of the distal axillary and proximal brachial arteries was also identified. This rare presentation highlights aberrant right subclavian artery thrombosis as an important cause of acute upper extremity ischemia and underscores the need to consider both congenital vascular variants and alternative thrombotic etiologies in the differential diagnosis of acute arterial occlusion. https://crcp.tums.ac.ir/index.php/crcp/article/view/1124 https://crcp.tums.ac.ir/index.php/crcp/article/download/1124/746