Acute Finger Ischemia in an Elderly Male without Risk Factors for Hypercoagulability.

Manish Amin,Amber Jones,Jason Jerome,Daniel Quesada,Phillip Aguìñiga-Navarrete,Angela Torres

doi:10.5811/cpcem.2019.11.45224

Abstract

Literature on ulnar artery thrombosis and acute finger ischemia is scant and usually related to underlying hypercoagulable or occlusive states, such as atrial fibrillation, thrombangiitis obliterans, vasospasm, trauma, and neurovascular compression at the root of the upper limb. An elderly hypertensive male without an underlying hypercoagulable state, and in otherwise good health, presented to our emergency department with acute multi-finger ischemia, and ulnar artery and palmar arch thromboses. Given his innocuous history, this case demonstrates the importance of maintaining acute arterial thrombosis on the differential for hand pain despite the obvious propensity toward mechanical injuries in the extremities.

Highlights

Literature on ulnar artery thrombosis and acute finger ischemia is scant and usually related to underlying hypercoagulable or occlusive states, such as atrial fibrillation, thrombangiitis obliterans, vasospasm, trauma, and neurovascular compression at the root of the upper limb
What do we already know about this clinical entity? Digital ischemia is an uncommon entity that occurs in patients with underlying hypercoagulable states
Common etiologies of acute finger ischemia include but are not limited to hypercoagulable states, atrial fibrillation, thrombangiitis obliterans, vasospasm, trauma, and neurovascular compression at the root of the upper limb.[1]. This case demonstrates the importance of physical exam maneuvers such as neurovascular testing, assessment of capillary refill and Allen’s test in diagnosing critical limb ischemia where a history of risk factors for arterial thrombi is absent