Farag Mohamed, Elmasry Mohamed, Mabote Thato, Elsayed Ayman, Sunthareswaran Rame
Department of General Medicine, Diana Princess of Wales Hospital, Grimsby, North East Lincolnshire, UK.
BMJ Case Rep. 2014 Jan 15;2014:bcr2013200290. doi: 10.1136/bcr-2013-200290.
The management of the acute blue finger is controversial with many regarding it as a benign condition. However, we would argue that it should always be considered as an emergency. We present a challenging case of a 43-year-old woman who presented with a 1-week history of sudden onset blue discolouration of the left fifth digit, and a 6-week history of episodic joint problems. Examination showed bilateral normal radial and ulnar pulses. Following blood investigations, an initial working diagnosis of early rheumatoid arthritis with associated Raynaud's phenomenon was made. Also, infective endocarditis was considered due to temporary misleading physical signs. Later, CT angiography of the left upper limb arteries showed a significant proximal left subclavian stenosis. Subsequently, a diagnosis of the left subclavian arteritis associated with digit ischaemia from embolic debris was made and the patient underwent a left subclavian angioplasty. However, delayed management resulted in a necrotic digit, which was left to autoamputate.
急性蓝手指的处理存在争议，许多人认为它是一种良性病症。然而，我们认为它应始终被视为紧急情况。我们呈现了一个具有挑战性的病例，一名43岁女性，有左小指突发蓝色变色1周的病史，以及间歇性关节问题6周的病史。检查显示双侧桡动脉和尺动脉搏动正常。血液检查后，初步诊断为早期类风湿关节炎伴雷诺现象。此外，由于暂时出现误导性体征，还考虑了感染性心内膜炎。后来，左上肢动脉CT血管造影显示左锁骨下动脉近端明显狭窄。随后，诊断为左锁骨下动脉炎伴栓塞碎片导致手指缺血，患者接受了左锁骨下动脉血管成形术。然而，治疗延迟导致手指坏死，任其自行脱落。
