Raynaud'S - Not All Created Equal
Joann Lohr1, Anil Verma, MD2.
1Lohr Surgical Specialists, Cincinnati, OH, USA, 2Mercy Health, Cincinnati, OH, USA.
OBJECTIVES: The medical community and emergency room needs increased awareness of the spectrum of hand complaints and potential for digit and limb loss.
METHODS: Retrospective chart review was performed on six patients who presented to the emergency room for evaluation of “blue fingers” and variable pain and neurologic symptoms.
RESULTS: All six were seen and discharged home for outpatient follow ups. All were seen at least twice and two were seen four times in various emergency centers before more aggressive evaluation and treatment was undertaken. One patient was on Tamoxifen for breast cancer, three were smokers, and one had an undiagnosed connective tissue disorder (CREST) with small vessel occlusions. Arterial Duplex evaluation and digital PPG's were all abnormal. Lytic therapy restored flow to four of the six limiting tissue loss. All of these patients had an associated underlying undiagnosed thrombophilic defect. All are being treated with lifelong anticoagulation.
CONCLUSIONS: Vague ischemia hand symptoms need to be aggressively evaluated. Imaging is mandatory to prevent thrombus propagation and increased potential for limb loss. A high suspicion for thrombophilia should be maintained. Women who have had mild symptoms may have associated underlying issues that cause rapid progression. These patients need urgent vascular evaluation not referral for routine evaluation in 6 or 8 weeks. Emergency room presentation of hand symptoms should be considered a harbinger of a potential more serious underlying problem. Vasospastic and obstructive disease etiologies need to be considered.
Back to 2020 ePosters