Multifocal bilateral palmar and digital varices

Multifocal bilateral palmar and digital varices 2762 Cardiovascular flashlight doi:10.1093/eurheartj/ehy087 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 26 February 2018 .................................................................................................................................................... 1 2 1 1 Gesa von Olshausen *, Daniela Pfeiffer , Arne Mu¨ller , and Tareq Ibrahim 1 2 Klinik und Poliklinik fu¨r Innere Medizin I, Klinikum Rechts der Isar, Technische Universit€at Mu¨nchen, Ismaningerstrasse 22, 81675 Munich, Germany; and Institut fu¨r diag- nostische und interventionelle Radiologie, Klinikum Rechts der Isar, Technische Universit€at Mu¨nchen, Ismaningerstrasse 22, 81675 Munich, Germany * Corresponding author. Tel:149-89-41402350, Fax:149-89-41404900, Email: gesa.olshausen@tum.de A 56-year-old woman presented with worsening pain of both hands and fingers for more than 6 months. The patient had been observing blue-livid vessel-like formations on fingers of both hands for 10 years. She was an architectural draughtsman and right-handed without any history of trauma, mechanical compression, or relevant long-term medication. Clinical examination revealed touch-sensitive warm hands and fingers with a bilateral blue-livid mottled pattern of the palmar and digital region (Panel A). Duplex ultrasound and oscillography of the upper extremities revealed a regular arterial vasculature but numerous ectatic venous vessels without evidence of thrombosis. We suspected multifocal palmar and digital varices and performed magnetic resonance imaging (MRI). T1-weighted pre- and post-contrast fat-saturated images (Panel B, C, and cineloops in Supplementary Material online)revealed multiple tubular structures in the subcutaneous tissue (white arrows) confirming the diagnosis of multifocal palmar and digital varices. Palmar and digital varices have been infrequently described in the literature usually presenting as solitary lesions at younger age. A rela- tionship to trauma or mechanical compression is central to the pathogenesis. Aging phlebectasia has also been considered as cause but mainly in more elderly patients. Diagnosis is commonly made based on anamnesis, ultrasound, and Penrose tourniquet application. However, MRI is a valuable tool to depict the extent of varices and provide information about infiltration of tendons or muscles and tumour/ganglion formation. Regular application of compression stocking and daily acetylsalicylic acid (ASS) generated substantial pain relief. In cases with persisting pain surgical curative excision of nodule varices might be a further option with good results. Supplementary material is available at European Heart Journal online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/29/2762/4911111 by Ed 'DeepDyve' Gillespie user on 07 August 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Multifocal bilateral palmar and digital varices

European Heart Journal , Volume 39 (29) – Aug 1, 2018
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Oxford University Press
Copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
ISSN
0195-668X
eISSN
1522-9645
D.O.I.
10.1093/eurheartj/ehy087
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Abstract

2762 Cardiovascular flashlight doi:10.1093/eurheartj/ehy087 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 26 February 2018 .................................................................................................................................................... 1 2 1 1 Gesa von Olshausen *, Daniela Pfeiffer , Arne Mu¨ller , and Tareq Ibrahim 1 2 Klinik und Poliklinik fu¨r Innere Medizin I, Klinikum Rechts der Isar, Technische Universit€at Mu¨nchen, Ismaningerstrasse 22, 81675 Munich, Germany; and Institut fu¨r diag- nostische und interventionelle Radiologie, Klinikum Rechts der Isar, Technische Universit€at Mu¨nchen, Ismaningerstrasse 22, 81675 Munich, Germany * Corresponding author. Tel:149-89-41402350, Fax:149-89-41404900, Email: gesa.olshausen@tum.de A 56-year-old woman presented with worsening pain of both hands and fingers for more than 6 months. The patient had been observing blue-livid vessel-like formations on fingers of both hands for 10 years. She was an architectural draughtsman and right-handed without any history of trauma, mechanical compression, or relevant long-term medication. Clinical examination revealed touch-sensitive warm hands and fingers with a bilateral blue-livid mottled pattern of the palmar and digital region (Panel A). Duplex ultrasound and oscillography of the upper extremities revealed a regular arterial vasculature but numerous ectatic venous vessels without evidence of thrombosis. We suspected multifocal palmar and digital varices and performed magnetic resonance imaging (MRI). T1-weighted pre- and post-contrast fat-saturated images (Panel B, C, and cineloops in Supplementary Material online)revealed multiple tubular structures in the subcutaneous tissue (white arrows) confirming the diagnosis of multifocal palmar and digital varices. Palmar and digital varices have been infrequently described in the literature usually presenting as solitary lesions at younger age. A rela- tionship to trauma or mechanical compression is central to the pathogenesis. Aging phlebectasia has also been considered as cause but mainly in more elderly patients. Diagnosis is commonly made based on anamnesis, ultrasound, and Penrose tourniquet application. However, MRI is a valuable tool to depict the extent of varices and provide information about infiltration of tendons or muscles and tumour/ganglion formation. Regular application of compression stocking and daily acetylsalicylic acid (ASS) generated substantial pain relief. In cases with persisting pain surgical curative excision of nodule varices might be a further option with good results. Supplementary material is available at European Heart Journal online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/29/2762/4911111 by Ed 'DeepDyve' Gillespie user on 07 August 2018

Journal

European Heart JournalOxford University Press

Published: Aug 1, 2018

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