Noon Report: Buerger's Disease

Orange Medicine gave us a really interesting report of Buerger's disease, or, Thromboangiitis obliterans today! 

Ulcerated and necrotic toe seen in Buerger's disease.

Buerger's disease is most common among young, male smokers.  It is a small and medium vessel nonatherosclerotic, inflammatory disease.  Early in the disease, patients may have sporadic pain and coldness in the affected extremities.   Late findings of skin ulcers or gangrene may require amputation especially if patients do not stop smoking as this is the only definitive treatment. 

The diagnosis can be made with the Shionoya clinical diagnostic criteria:  (1) smoking history, (2) onset before the age of 50 years, (3) infrapopliteal arterial occlusions, (4) either upper limb involvement or phlebitis migrans, and (5) absence of atherosclerotic risk factors other than smoking.  Angiography usually shows arterial occlusion and classicaly “cork-screw” collateral arteries.

"cork-screw arteries"

It is important to keep in mind the differential for this disease which is not commonly seen.  Among the differentials are Behcet's disease, polyarteritis nodosa, Raynaud's, and cryoglobulinemia as well as the other brialliant ones we put up on the board today. 

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Authored by: ELLIOTT WELFORD, MD