Difference between revisions of "Thromboangiitis obliterans"

(Differential Diagnosis)
(Clinical Features)
 
(18 intermediate revisions by 4 users not shown)
Line 1: Line 1:
 
==Background==
 
==Background==
*AKA Thromboangiitis Obliterates
+
*Also known as "Buerger's disease"
 +
*Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)
  
===Pathophysiology===
+
===Risk factors===
* Idiopathic inflammatory occlusive disease of the hands and feet
+
*Tobacco use
**Exact pathogenesis unknown
+
**Virtually all affected patients are smokers
 
+
*Male
===Risk Factors===
+
*Middle Eastern
*Male, tobacco, Middle Eastern
 
**Virtually all patients are smokers
 
  
 
==Clinical Features==
 
==Clinical Features==
 +
[[File:PMC3371931 ircmj-13-420-g001.png|thumb|Thromboangiitis obliterans of foot]]
 +
[[File:PMC5024906 AJUM-14-18-g002.png|thumb]]
 
*Red, tender nodules over peripheral arteries
 
*Red, tender nodules over peripheral arteries
**+/- diminished pulses
+
**May have diminished pulses
 
*In-step claudication
 
*In-step claudication
 
*Hand claudication
 
*Hand claudication
**Often bilateral & symmetrical  
+
**Often bilateral and symmetrical  
 
**May lead to ulceration
 
**May lead to ulceration
 +
*Raynaud phenomenon
 +
*Gangrene and autoamputation of digits in severe disease
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*Chronic PAD
+
{{Blue digit DDX}}
**Atherosclerosis Obliterans
 
 
 
*Acute PAD
 
**Atheroembolism (AKA Blue Toe Syndrome)
 
**Arterial embolism
 
**Arterial thrombosis
 
 
 
*Vasospastic Disorders
 
**Raynaud’s Disease
 
**Primary Erythromelalgia
 
  
 
==Evaluation==
 
==Evaluation==
*Clinical criteria for Dx (noninvasive testing not necessary)
+
*Clinical criteria for diagnosis (noninvasive testing not necessary)
 
**History of smoking
 
**History of smoking
**Onset prior to <50 y/o
+
**Onset prior to <50 years old
 
**Absence of atherosclerotic risk factors
 
**Absence of atherosclerotic risk factors
 
**Upper limb involvement
 
**Upper limb involvement
Line 41: Line 34:
 
==Management==
 
==Management==
 
*Abstinence from tobacco
 
*Abstinence from tobacco
*Early symptoms w/o threatened tissue loss: outpatient vascular  
+
*Early symptoms with out threatened tissue loss: outpatient vascular  
*Advanced disease: intra-arterial or intravenous PGE1, ASA, Heparin, arterial reconstruction, sympathectomy
+
*Advanced disease: intra-arterial or intravenous PGE1, [[ASA]], [[Heparin]], arterial reconstruction, sympathectomy
  
 
==Disposition==
 
==Disposition==
 +
*Discharge with vascular follow-up if no evidence/threat of tissue loss
 +
*Otherwise admit
  
 
==See Also==
 
==See Also==
Line 53: Line 48:
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 +
==Video==
 +
{{#widget:YouTube|id=daB4UWA7RXk}}
 +
 +
[[Category:Vascular]]

Latest revision as of 20:13, 19 March 2019

Background

  • Also known as "Buerger's disease"
  • Idiopathic inflammatory occlusive disease of the hands and feet (exact pathogenesis unknown)

Risk factors

  • Tobacco use
    • Virtually all affected patients are smokers
  • Male
  • Middle Eastern

Clinical Features

Thromboangiitis obliterans of foot
PMC5024906 AJUM-14-18-g002.png
  • Red, tender nodules over peripheral arteries
    • May have diminished pulses
  • In-step claudication
  • Hand claudication
    • Often bilateral and symmetrical
    • May lead to ulceration
  • Raynaud phenomenon
  • Gangrene and autoamputation of digits in severe disease

Differential Diagnosis

Blue Digit

Evaluation

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

Management

  • Abstinence from tobacco
  • Early symptoms with out 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


Video