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An 86-year-old lad~ who had a cervical rib excised 25 years ago, presented with an acutely ischaemic right arm. On examination there was a pulsatile mass in the right supraclavicular fossa and no palpable pulses distally. Arteriography confirmed the presence of a 16mm diameter subclavian artery aneurysm and an embolus lodged at the bifurcation of the brachial artery (Fig. 1). She was anticoagulated with heparin and a brachial embolectomy was performed under local anaesthesia. A catheter was placed into the brachiocephalic artery via a right femoral artery puncture. This enabled continuous visualisation of the aneurysm during deployment of the endoprosthesis and facilitated accurate placement. A 10mm × 60mm covered Cragg Nitinol stent (Mintec Inc.) was deployed in the conventional manner from the right brachial arteriotomy. This involved first crossing the lesion with a guide-wire, passing a long 9 Fr sheath across the

Many of the congenital neurocutaneous disorders show well-known specific radiological changes which can be visualized by routine radiography. However, the advent of new imaging techniques permits more detailed analysis of internal lesions, including their early development, and thus in some instances earlier diagnosis may be achieved. Moreover, such methods may obviate the need for more invasive investigations. We demonstrate the application of these techniques in four phakomatoses, namely neurofibromatosis, tuberose sclerosis, Sturge-Weber syndrome and von Hippel-Lindau syndrome. Amongst the more important and readily available of these methods are computerized tomography, ultrasonography, magnetic resonance imaging and digital subtraction angiography. The value of these techniques is exemplified by the use of computerized tomography in tuberose sclerosis; after recognition of the cutaneous features, central nervous system involvement is identifiable many months before routine radiological detection of intracranial calcification. Further examples of the clinical application are detailed in each instance.