Difference between revisions of "Thromboangiitis obliterans"

(Clinical Features)
(Differential Diagnosis)
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==Differential Diagnosis==
 
==Differential Diagnosis==
*Chronic peripheral artery disease
+
*Chronic [[peripheral artery disease]]
 
**Atherosclerosis Obliterans
 
**Atherosclerosis Obliterans
 
*Acute PAD
 
*Acute PAD
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**Arterial thrombosis
 
**Arterial thrombosis
 
*Vasospastic Disorders
 
*Vasospastic Disorders
**Raynaud’s Disease
+
**Raynaud’s disease
 
**Primary Erythromelalgia
 
**Primary Erythromelalgia
 
*Autoimmune
 
*Autoimmune
**Scleroderma
+
**[[Scleroderma]]
**SLE
+
**[[SLE]]
  
 
==Evaluation==
 
==Evaluation==

Revision as of 13:25, 14 February 2017

Background

  • Also known as Thromboangiitis Obliterans
  • Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)
  • Risk factors: Male, tobacco users, Middle Eastern
    • Virtually all affected patients are smokers

Clinical Features

  • Red, tender nodules over peripheral arteries
    • May have diminished pulses
  • In-step claudication
  • Hand claudication
    • Often bilateral and symmetrical
    • May lead to ulceration

Differential Diagnosis

  • Chronic peripheral artery disease
    • Atherosclerosis Obliterans
  • Acute PAD
    • Atheroembolism (AKA Blue Toe Syndrome)
    • Arterial embolism
    • Arterial thrombosis
  • Vasospastic Disorders
    • Raynaud’s disease
    • Primary Erythromelalgia
  • Autoimmune

Evaluation

  • Clinical criteria for Dx (noninvasive testing not necessary)
    • History of smoking
    • Onset prior to <50 y/o
    • Absence of atherosclerotic risk factors
    • Upper limb involvement
    • Infrapopliteal arterial occlusive lesions

Management

  • Abstinence from tobacco
  • Early symptoms w/o threatened tissue loss: outpatient vascular
  • Advanced disease: intra-arterial or intravenous PGE1, ASA, Heparin, arterial reconstruction, sympathectomy

Disposition

  • Discharge with vascular follow-up if no evidence/threat of tissue loss
  • Otherwise admit

See Also

External Links

References