Thromboangiitis obliterans - Revision history

Michael: /* Sign out */ fix sp

2013-07-16T16:24:41Z

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	==Sign out==		==Sign out==
	<pre>		<pre>
	MIDDLE FINGER DISTAL ~~PHALYNX~~, LEFT, AMPUTATION:		MIDDLE FINGER DISTAL PHALANX, LEFT, AMPUTATION:
	- ENDARTERITIS, PERIARTERITIS, INTRAVASCULAR THROMBI AND GANGRENE CONSISTENT WITH		- ENDARTERITIS, PERIARTERITIS, INTRAVASCULAR THROMBI AND GANGRENE CONSISTENT WITH
	THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).		THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).

Michael: /* Formal clinical criteria */

2013-07-16T16:17:40Z

Formal clinical criteria

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	===Formal clinical criteria===		===Formal clinical criteria===
	All of the following - as per ''~~Olin~~'':<ref name=~~pmid10995867~~>{{Cite journal \| last1 = ~~Olin~~ \| first1 = JW. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = ~~N Engl~~ J ~~Med~~ \| volume = ~~343~~ \| issue = 12 \| pages = ~~864-9~~ \| month = ~~Sep~~ \| year = ~~2000~~ \| doi = 10.~~1056~~/~~NEJM200009213431207~~ \| PMID = ~~10995867~~ \| URL = http://www.~~nejm~~.~~org~~/~~doi~~/~~full~~/~~10.1056~~/~~NEJM200009213431207~~ }}</ref><ref name=~~pmid16722538~~>{{Cite journal \| last1 = ~~Arkkila~~ \| first1 = PE. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = ~~Orphanet~~ J ~~Rare Dis~~ \| volume = 1 \| issue = \| pages = 14 \| month = \| year = ~~2006~~ \| doi = 10.~~1186~~/~~1750-1172-1-14~~ \| PMID = ~~16722538~~ \| URL = http://www.~~ncbi~~.~~nlm.nih.gov~~/~~pmc~~/~~articles~~/~~PMC1523324~~/ ~~\| PMC = 1523324~~ }}</ref>		====Simple====
			All of the following - as per ''Shionoya'':<ref name=pmid16722538>{{Cite journal \| last1 = Arkkila \| first1 = PE. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = Orphanet J Rare Dis \| volume = 1 \| issue = \| pages = 14 \| month = \| year = 2006 \| doi = 10.1186/1750-1172-1-14 \| PMID = 16722538 \| URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523324/ \| PMC = 1523324 }}</ref>
			*Smoking.
			**No other atherosclerosis risk factors.
			*Onset < 50 years old.
			*Infrapopliteal arterial occlusions.
			*Arm involvement ''or'' phlebitis migrans;

			====Complicated====
			All of the following - as per ''Olin'':<ref name=pmid10995867>{{Cite journal \| last1 = Olin \| first1 = JW. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = N Engl J Med \| volume = 343 \| issue = 12 \| pages = 864-9 \| month = Sep \| year = 2000 \| doi = 10.1056/NEJM200009213431207 \| PMID = 10995867 \| URL = http://www.nejm.org/doi/full/10.1056/NEJM200009213431207 }}</ref>
	*Less than 45 years old.		*Less than 45 years old.
	*Current or recent tobacco use.		*Current or recent tobacco use.
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	*Arteriographic findings consistent with the disease.		*Arteriographic findings consistent with the disease.

	Exclusions - with lab tests:<ref name=pmid16722538~~/><ref name=pmid10995867~~/>		Exclusions - with lab tests:<ref name=pmid16722538/>
	*Autoimmune disease.		*Autoimmune disease.
	*Hypercoagulable state.		*Hypercoagulable state.

Michael at 16:13, 16 July 2013

2013-07-16T16:13:29Z

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	** Endarteritis - neutrophils at the internal elastic lamina (IEL).		** Endarteritis - neutrophils at the internal elastic lamina (IEL).
	** Periarteritis - neutrophils around the arteries.		** Periarteritis - neutrophils around the arteries.
	*~~Obliteration of the lumen~~.		*Luminal narrowing due to thrombi.<ref name=pmid16722538/>
	**~~Thrombi~~.		**Organizing thrombi = thickened tunica intima.
	**~~Organizing thrombi~~ - ~~thickened tunica intima~~.		**Vessels may be re-canalized.

	Notes:		Notes:

Michael: /* Sign out */

2013-07-16T16:08:18Z

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← Older revision		Revision as of 16:08, 16 July 2013
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	<pre>		<pre>
	MIDDLE FINGER DISTAL PHALYNX, LEFT, AMPUTATION:		MIDDLE FINGER DISTAL PHALYNX, LEFT, AMPUTATION:
	- ENDARTERITIS, PERIARTERITIS ~~AND~~ INTRAVASCULAR THROMBI CONSISTENT WITH		- ENDARTERITIS, PERIARTERITIS, INTRAVASCULAR THROMBI AND GANGRENE CONSISTENT WITH
	THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).		THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).
	</pre>		</pre>

Michael: /* Sign out */

2013-07-16T16:06:42Z

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← Older revision		Revision as of 16:06, 16 July 2013
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	<pre>		<pre>
	MIDDLE FINGER DISTAL PHALYNX, LEFT, AMPUTATION:		MIDDLE FINGER DISTAL PHALYNX, LEFT, AMPUTATION:
	- ~~GANGRENE WITH~~ ENDARTERITIS, PERIARTERITIS AND ~~LUMINAL OBLITERATION/NARROWING~~		- ENDARTERITIS, PERIARTERITIS AND INTRAVASCULAR THROMBI CONSISTENT WITH
	~~CONSISTENT WITH~~ THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).		THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).
	</pre>		</pre>

Michael at 16:05, 16 July 2013

2013-07-16T16:05:42Z

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	*Stop smoking.<ref name=pmid22284771>{{Cite journal \| last1 = Dargon \| first1 = PT. \| last2 = Landry \| first2 = GJ. \| title = Buerger's disease. \| journal = Ann Vasc Surg \| volume = 26 \| issue = 6 \| pages = 871-80 \| month = Aug \| year = 2012 \| doi = 10.1016/j.avsg.2011.11.005 \| PMID = 22284771 }}</ref>		*Stop smoking.<ref name=pmid22284771>{{Cite journal \| last1 = Dargon \| first1 = PT. \| last2 = Landry \| first2 = GJ. \| title = Buerger's disease. \| journal = Ann Vasc Surg \| volume = 26 \| issue = 6 \| pages = 871-80 \| month = Aug \| year = 2012 \| doi = 10.1016/j.avsg.2011.11.005 \| PMID = 22284771 }}</ref>

	===Formal criteria===		===Formal clinical criteria===
	All of the following:<ref name=~~pmid16722538~~>{{Cite journal \| last1 = ~~Arkkila~~ \| first1 = PE. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = ~~Orphanet~~ J ~~Rare Dis~~ \| volume = 1 \| issue = \| pages = 14 \| month = \| year = ~~2006~~ \| doi = 10.~~1186~~/~~1750-1172-1-14~~ \| PMID = ~~16722538~~ \| URL = http://www.~~ncbi~~.~~nlm.nih.gov~~/~~pmc~~/~~articles~~/~~PMC1523324~~/ ~~\| PMC = 1523324~~ }}</ref><ref name=~~pmid10995867~~>{{Cite journal \| last1 = ~~Olin~~ \| first1 = JW. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = ~~N Engl~~ J ~~Med~~ \| volume = ~~343~~ \| issue = 12 \| pages = ~~864-9~~ \| month = ~~Sep~~ \| year = ~~2000~~ \| doi = 10.~~1056~~/~~NEJM200009213431207~~ \| PMID = ~~10995867~~ \| URL = http://www.~~nejm~~.~~org~~/~~doi~~/~~full~~/~~10.1056~~/~~NEJM200009213431207~~ }}</ref>		All of the following - as per ''Olin'':<ref name=pmid10995867>{{Cite journal \| last1 = Olin \| first1 = JW. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = N Engl J Med \| volume = 343 \| issue = 12 \| pages = 864-9 \| month = Sep \| year = 2000 \| doi = 10.1056/NEJM200009213431207 \| PMID = 10995867 \| URL = http://www.nejm.org/doi/full/10.1056/NEJM200009213431207 }}</ref><ref name=pmid16722538>{{Cite journal \| last1 = Arkkila \| first1 = PE. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = Orphanet J Rare Dis \| volume = 1 \| issue = \| pages = 14 \| month = \| year = 2006 \| doi = 10.1186/1750-1172-1-14 \| PMID = 16722538 \| URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523324/ \| PMC = 1523324 }}</ref>
	*Less than 45 years old.		*Less than 45 years old.
	*Current or recent tobacco use.		*Current or recent tobacco use.
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	** Endarteritis - neutrophils at the internal elastic lamina (IEL).		** Endarteritis - neutrophils at the internal elastic lamina (IEL).
	** Periarteritis - neutrophils around the arteries.		** Periarteritis - neutrophils around the arteries.
	*Obliteration of the lumen - ~~intimal thickening~~.		*Obliteration of the lumen.
			**Thrombi.
			**Organizing thrombi - thickened tunica intima.

	Notes:		Notes:

Michael: /* Formal criteria */

2013-07-16T15:57:53Z

Formal criteria

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	*Sign or symptoms of distal extremity ischemia (claudication, pain at rest, ulcers, gangrene).		*Sign or symptoms of distal extremity ischemia (claudication, pain at rest, ulcers, gangrene).
	*Arteriographic findings consistent with the disease.		*Arteriographic findings consistent with the disease.
	*Exclusions - with lab tests:
	**Autoimmune disease.		Exclusions - with lab tests:<ref name=pmid16722538/><ref name=pmid10995867/>
	**Hypercoagulable state.		*Autoimmune disease.
	**Diabetes mellitus.		*Hypercoagulable state.
	**Radiographic findings suggestive of proximal emboli source (echocardiography, arteriography).		*[[Diabetes mellitus]].
			*Radiographic findings suggestive of proximal emboli source (echocardiography, arteriography).

	==Gross==		==Gross==

Michael: /* General */

2013-07-16T15:56:35Z

General

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	Treatment:		Treatment:
	*Stop smoking.<ref name=pmid22284771>{{Cite journal \| last1 = Dargon \| first1 = PT. \| last2 = Landry \| first2 = GJ. \| title = Buerger's disease. \| journal = Ann Vasc Surg \| volume = 26 \| issue = 6 \| pages = 871-80 \| month = Aug \| year = 2012 \| doi = 10.1016/j.avsg.2011.11.005 \| PMID = 22284771 }}</ref>		*Stop smoking.<ref name=pmid22284771>{{Cite journal \| last1 = Dargon \| first1 = PT. \| last2 = Landry \| first2 = GJ. \| title = Buerger's disease. \| journal = Ann Vasc Surg \| volume = 26 \| issue = 6 \| pages = 871-80 \| month = Aug \| year = 2012 \| doi = 10.1016/j.avsg.2011.11.005 \| PMID = 22284771 }}</ref>

			===Formal criteria===
			All of the following:<ref name=pmid16722538>{{Cite journal \| last1 = Arkkila \| first1 = PE. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = Orphanet J Rare Dis \| volume = 1 \| issue = \| pages = 14 \| month = \| year = 2006 \| doi = 10.1186/1750-1172-1-14 \| PMID = 16722538 \| URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523324/ \| PMC = 1523324 }}</ref><ref name=pmid10995867>{{Cite journal \| last1 = Olin \| first1 = JW. \| title = Thromboangiitis obliterans (Buerger's disease). \| journal = N Engl J Med \| volume = 343 \| issue = 12 \| pages = 864-9 \| month = Sep \| year = 2000 \| doi = 10.1056/NEJM200009213431207 \| PMID = 10995867 \| URL = http://www.nejm.org/doi/full/10.1056/NEJM200009213431207 }}</ref>
			*Less than 45 years old.
			*Current or recent tobacco use.
			*Sign or symptoms of distal extremity ischemia (claudication, pain at rest, ulcers, gangrene).
			*Arteriographic findings consistent with the disease.
			*Exclusions - with lab tests:
			**Autoimmune disease.
			**Hypercoagulable state.
			**Diabetes mellitus.
			**Radiographic findings suggestive of proximal emboli source (echocardiography, arteriography).

	==Gross==		==Gross==

Michael at 15:44, 16 July 2013

2013-07-16T15:44:23Z

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	'''Thromboangiitis obliterans''', abbreviated '''TAO''', is a rare [[vascular disease]] characterized by recurrent thrombosis. It primarily afflicts young smokers and is also known as '''Buerger disease'''.		'''Thromboangiitis obliterans''', abbreviated '''TAO''', is a rare [[vascular disease]] characterized by recurrent thrombosis. It primarily afflicts young smokers and is also known as '''Buerger disease'''.

	**Should '''not''' be confused with ''Berger disease'' ([[IgA nephropathy]]).		It should '''not''' be confused with '''Berger disease''' ([[IgA nephropathy]]).

	==General==		==General==

Michael: split out

2013-07-16T15:42:56Z

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	~~#redirect~~ [[~~Vascular_disease#Thromboangiitis_obliterans~~]]		'''Thromboangiitis obliterans''', abbreviated '''TAO''', is a rare [[vascular disease]] characterized by recurrent thrombosis. It primarily afflicts young smokers and is also known as '''Buerger disease'''.

			**Should '''not''' be confused with ''Berger disease'' ([[IgA nephropathy]]).

			==General==
			*Strong association with smoking.<ref>{{Cite journal \| last1 = Highlander \| first1 = P. \| last2 = Southerland \| first2 = CC. \| last3 = VonHerbulis \| first3 = E. \| last4 = Gonzalez \| first4 = A. \| title = Buerger disease (thromboangiitis obliterans): a clinical diagnosis. \| journal = Adv Skin Wound Care \| volume = 24 \| issue = 1 \| pages = 15-7 \| month = Jan \| year = 2011 \| doi = 10.1097/01.ASW.0000392923.37852.43 \| PMID = 21173586 }}</ref>
			*Clinical-radiologic diagnosis.<ref name=pmid20534945/>

			Typical symptoms/signs - progression:<ref name=pmid22284771/>
			*Intermittent claudication -> ulcers -> [[gangrene]] -> [[amputation]].

			Treatment:
			*Stop smoking.<ref name=pmid22284771>{{Cite journal \| last1 = Dargon \| first1 = PT. \| last2 = Landry \| first2 = GJ. \| title = Buerger's disease. \| journal = Ann Vasc Surg \| volume = 26 \| issue = 6 \| pages = 871-80 \| month = Aug \| year = 2012 \| doi = 10.1016/j.avsg.2011.11.005 \| PMID = 22284771 }}</ref>

			==Gross==
			*Afflicts small and medium-sized vessels of the extremities.
			*Corkscrew vessels - seen on angiography.<ref name=pmid20534945>{{Cite journal \| last1 = Fujii \| first1 = Y. \| last2 = Soga \| first2 = J. \| last3 = Nakamura \| first3 = S. \| last4 = Hidaka \| first4 = T. \| last5 = Hata \| first5 = T. \| last6 = Idei \| first6 = N. \| last7 = Fujimura \| first7 = N. \| last8 = Nishioka \| first8 = K. \| last9 = Chayama \| first9 = K. \| title = Classification of corkscrew collaterals in thromboangiitis obliterans (Buerger's disease): relationship between corkscrew type and prevalence of ischemic ulcers. \| journal = Circ J \| volume = 74 \| issue = 8 \| pages = 1684-8 \| month = Aug \| year = 2010 \| doi = \| PMID = 20534945 }}</ref>

			==Microscopic==
			Features:<ref name=pmid16892557>{{Cite journal \| last1 = Kurata \| first1 = A. \| last2 = Schulz \| first2 = A. \| last3 = Franke \| first3 = FE. \| title = Reappraisal of thromboangiitis obliterans--a pathological contribution. \| journal = Verh Dtsch Ges Pathol \| volume = 88 \| issue = \| pages = 231-6 \| month = \| year = 2004 \| doi = \| PMID = 16892557 }}</ref>
			*Acute inflammation:
			** Endarteritis - neutrophils at the internal elastic lamina (IEL).
			** Periarteritis - neutrophils around the arteries.
			*Obliteration of the lumen - intimal thickening.

			Notes:
			* Typically segmental.<ref name=pmid22284771/>

			DDx:
			*[[Peripheral vascular disease]] ([[atherosclerosis]]) - typically lacks the acute inflammation around the IEL and around the vessels.
			*[[Vasculitis]] - have [[fibrinoid necrosis]].

			Images:
			*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=2008080217555643 Buerger's disease (surgicalpathologyatlas.com)].

			==Sign out==
			<pre>
			MIDDLE FINGER DISTAL PHALYNX, LEFT, AMPUTATION:
			- GANGRENE WITH ENDARTERITIS, PERIARTERITIS AND LUMINAL OBLITERATION/NARROWING
			CONSISTENT WITH THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE).
			</pre>

			==See also==
			*[[Vascular disease]].

			==References==
			{{Reflist\|2}}

	[[Category:Diagnosis]]		[[Category:Diagnosis]]
			[[Category:Cardiovascular pathology]]