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. 2020 Apr-Jun;13(2):178-180.
doi: 10.4103/JCAS.JCAS_162_19.

A Late Presentation of Hand Pain with Skin Changes

Fady P Marji  1 , Grant M Kleiber  2
Affiliations

A Late Presentation of Hand Pain with Skin Changes

Fady P Marji et al. J Cutan Aesthet Surg. 2020 Apr-Jun.

Abstract

A middle-aged homeless man presented with ongoing left-hand pain and worsening cutaneous phalangeal color changes. On examination, digital ischemia was observed with associated dry gangrene. Doppler examination showed impaired distal arterial flow. Angiography showed irregular digital perfusion. The patient later provided vital information to secure the diagnosis without further clinical workup. This quiz discusses the presentation, differential diagnosis, and treatment of a rare clinical scenario.

Keywords: Cutaneous infarction; digital gangrene; hand ischemia; intra-arterial drug injection (IADI); microembolization.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Volar view of patient’s hand depicting ischemic skin changes. Note the distal cyanosis and edema of phalanges II–IV, as well as the appearance of dry gangrene indicating cutaneous infarction
Figure 2
Figure 2
Dorsal view of patient’s hand depicting cyanosis and edema of the digits, as well as necrosis of tissue at the nailbeds. Peripheral ulceration is noted circumscribing the areas of infarcted skin, as well as a punctate ulcer on phalanx II
Figure 3
Figure 3
Angiogram showing patent radial and ulnar artery flow at the wrist, with attenuated palmar and digital perfusion
See this image and copyright information in PMC

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