Images in Corkscrew collaterals in Raynaud s …...Corkscrew collaterals in Raynaud’s syndrome...
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Corkscrew collaterals in Raynaud’s syndrome Yuichi Fujii, 1 Hiroki Teragawa, 1 Yasuki Kihara, 2 Yukihito Higashi 3 1 Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan 2 Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan 3 Department of Human Genetics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan Correspondence to Dr Yuichi Fujii, [email protected] Accepted 22 April 2016 To cite: Fujii Y, Teragawa H, Kihara Y, et al. BMJ Case Rep Published online: [ please include Day Month Year] doi:10.1136/ bcr-2016-215841 DESCRIPTION Raynaud’s syndrome (RS) is an episodic peripheral vasospasm induced by cold stress. It is important to distinguish secondary obstructive RS from primary vasospastic RS because the former is associated with a poor prognosis. However, there is no con- sensus test for distinguishing secondary from primary RS. We describe a case of a 64-year-old woman who presented with pain and cyanosis in her fingertips on exposure to the cold ( figure 1). She was weakly positive for antinuclear antibodies but did not fulfil the diagnostic criteria for connective tissue diseases. Early treatments, including medication with a calcium channel blocker and prostaglandin analo- gues, did not improve her symptoms. Digital sub- traction angiography revealed multiple occlusions of the digital arteries, with corkscrew collaterals surrounding the avascular area ( figure 2, black arrow). Corkscrew collateral arteries in the digit of the right hand were able to be visualised as a snake sign, using duplex ultrasonography ( figure 3, video 1). Recently, ultrasonography has been in use to identify corkscrew collaterals that develop after an occlusion of the main trunk. 12 Their existence in patients with RS indicates secondary obstructive RS. Colour duplex ultrasonography is useful for the diagnosis of primary and secondary RS. Learning points ▸ Corkscrew collateral arteries in digits can be visualised by colour duplex ultrasonography. ▸ Colour duplex ultrasonography is useful for the diagnosis of primary and secondary Raynaud’s syndrome. Figure 1 Cyanosis was observed in the fingertips on exposure to cold. Figure 2 Digital subtraction angiography showing occlusions of digital arteries, with corkscrew collaterals (arrow). Figure 3 Corkscrew collaterals were detected by colour duplex ultrasonography. Video 1 Corkscrew collaterals were detected by colour duplex ultrasonography. Fujii Y, et al. BMJ Case Rep 2016. doi:10.1136/bcr-2016-215841 1 Images in … on 21 June 2020 by guest. Protected by copyright. http://casereports.bmj.com/ BMJ Case Reports: first published as 10.1136/bcr-2016-215841 on 6 May 2016. Downloaded from
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Corkscrew collaterals in Raynaud’s syndromeYuichi Fujii,1 Hiroki Teragawa,1 Yasuki Kihara,2 Yukihito Higashi3
1Department of CardiovascularMedicine, JR HiroshimaHospital, Hiroshima, Japan2Department of CardiovascularMedicine, Hiroshima UniversityGraduate School of Biomedicaland Health Sciences,Hiroshima, Japan3Department of HumanGenetics, Research Institute forRadiation Biology andMedicine, Hiroshima University,Hiroshima, Japan
Correspondence toDr Yuichi Fujii,[email protected]
Accepted 22 April 2016
To cite: Fujii Y,Teragawa H, Kihara Y, et al.BMJ Case Rep Publishedonline: [please include DayMonth Year] doi:10.1136/bcr-2016-215841
DESCRIPTIONRaynaud’s syndrome (RS) is an episodic peripheralvasospasm induced by cold stress. It is important todistinguish secondary obstructive RS from primaryvasospastic RS because the former is associatedwith a poor prognosis. However, there is no con-sensus test for distinguishing secondary fromprimary RS.We describe a case of a 64-year-old woman who
presented with pain and cyanosis in her fingertipson exposure to the cold (figure 1). She was weaklypositive for antinuclear antibodies but did not fulfil
the diagnostic criteria for connective tissue diseases.Early treatments, including medication with acalcium channel blocker and prostaglandin analo-gues, did not improve her symptoms. Digital sub-traction angiography revealed multiple occlusionsof the digital arteries, with corkscrew collateralssurrounding the avascular area (figure 2, blackarrow). Corkscrew collateral arteries in the digit ofthe right hand were able to be visualised as a snakesign, using duplex ultrasonography (figure 3, video1). Recently, ultrasonography has been in use toidentify corkscrew collaterals that develop after anocclusion of the main trunk.1 2 Their existence inpatients with RS indicates secondary obstructiveRS. Colour duplex ultrasonography is useful forthe diagnosis of primary and secondary RS.
Learning points
▸ Corkscrew collateral arteries in digits can bevisualised by colour duplex ultrasonography.
▸ Colour duplex ultrasonography is useful for thediagnosis of primary and secondary Raynaud’ssyndrome.
Figure 1 Cyanosis was observed in the fingertips onexposure to cold.
Figure 2 Digital subtraction angiography showingocclusions of digital arteries, with corkscrew collaterals(arrow).
Figure 3 Corkscrew collaterals were detected by colourduplex ultrasonography.
Video 1 Corkscrew collaterals were detected by colourduplex ultrasonography.
Fujii Y, et al. BMJ Case Rep 2016. doi:10.1136/bcr-2016-215841 1
Images in… on 21 June 2020 by guest. P
rotected by copyright.http://casereports.bm
j.com/
BM
J Case R
eports: first published as 10.1136/bcr-2016-215841 on 6 May 2016. D
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Contributors YF and YK contributed to drafting the article and conception of thisstudy; HT was involved in performing the angiography; YF was involved inperforming the duplex ultrasonography; YF and YH contributed to revising the articlecritically for important intellectual content.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES1 Fujii Y, Nishioka K, Yoshizumi M, et al. Images in cardiovascular medicine. Corkscrew
collaterals in thromboangitis obliterans (Buerger’s disease). Circulation 2007;116:e539–40.
2 Heil M, Schaper W. Influence of mechanical, cellular, and molecular factors oncollateral artery growth (arteriogenesis). Circ Res 2004;95:449–58.
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2 Fujii Y, et al. BMJ Case Rep 2016. doi:10.1136/bcr-2016-215841
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rotected by copyright.http://casereports.bm
j.com/
BM
J Case R
eports: first published as 10.1136/bcr-2016-215841 on 6 May 2016. D
ownloaded from
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Corkscrew collaterals in Raynaud's syndromeDescriptionReferences
