Angina Bullosa Hemorrhagica Workup

  • Author: Roman Carlos, DDS; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 29, 2010
 

Laboratory Studies

In angina bullosa hemorrhagica (ABH), platelet counts and coagulation tests are within normal limits.

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Procedures

Performing a biopsy of an intact bulla is difficult because of the short duration of the lesion.

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Histologic Findings

The diagnosis of angina bullosa hemorrhagica essentially is clinical; however, in the cases in which a biopsy has being taken, the microscopic examination reveals a subepithelial bulla filled with blood and an underlying mild and nonspecific mononuclear inflammatory cell infiltrate that generally is limited to the region of the lamina propria. Occasionally, neutrophils may be seen.[10]

Performing a biopsy of an intact bulla is difficult because of the short duration the lesion stays intact. Otherwise, a biopsy of a ruptured bulla exhibits just a nonspecific ulceration. According to Stephenson et al,[11] direct immunostaining for immunoglobulin G, immunoglobulin A, or C3 consistently are noncontributory.

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Contributor Information and Disclosures
Author

Roman Carlos, DDS  Staff Member, Department of Pathology, Hospital Herrera-Llerandi, Guatemala; Co-Director, Professor, Oral and Maxillofacial Pathology, Centro de Medicina Oral de Guatemala; Past President, International Association of Oral Pathologists; Chairman, Oral and Maxillofacial Pathology, Centro Clínico de Cabeza y Cuello, Guatemala; Diplomate, American Board of Oral and Maxillofacial Pathology

Roman Carlos, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and International Association of Oral Pathologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Terry L Barrett, MD  Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas

Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Pahl C, Yarrow S, Steventon N, Saeed NR, Dyar O. Angina bullosa haemorrhagica presenting as acute upper airway obstruction. Br J Anaesth. Feb 2004;92(2):283-6. [Medline].

  2. Grinspan D, Abulafia J, Lanfranchi H. Angina bullosa hemorrhagica. Int J Dermatol. Jul 1999;38(7):525-8. [Medline].

  3. Yamamoto K, Fujimoto M, Inoue M, Maeda M, Yamakawa N, Kirita T. Angina bullosa hemorrhagica of the soft palate: report of 11 cases and literature review. J Oral Maxillofac Surg. Sep 2006;64(9):1433-6. [Medline].

  4. Garlick JA, Calderon S. Oral blood blisters in angina bullosa haemorrhagica secondary to trauma of eating and dental injection. Br Dent J. Oct 22 1988;165(8):286-7. [Medline].

  5. Corson MA, Sloan P. Angina bullosa haemorrhagica: an unusual complication following crown preparation. Br Dent J. Jan 6 1996;180(1):24-5. [Medline].

  6. Curran AE, Rives RW. Angina bullosa hemorrhagica: an unusual problem following periodontal therapy. J Periodontol. Nov 2000;71(11):1770-3. [Medline].

  7. de las Heras ME, Moreno R, Núñez M, Gómez MI, Ledo A. Angina bullosa hemorrhagica. J Dermatol. Jul 1996;23(7):507-9. [Medline].

  8. Higgins EM, du Vivier AW. Angina bullosa haemorrhagica--a possible relation to steroid inhalers. Clin Exp Dermatol. Jul 1991;16(4):244-6. [Medline].

  9. Horie N, Kawano R, Inaba J, et al. Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases. J Oral Sci. Mar 2008;50(1):33-6. [Medline].

  10. Curran AE, Rives RW. Angina bullosa hemorrhagica: an unusual problem following periodontal therapy. J Periodontol. Nov 2000;71(11):1770-3. [Medline].

  11. Stephenson P, Scully C, Prime SS, Daly HM. Angina bullosa haemorrhagica: lesional immunostaining and haematological findings. Br J Oral Maxillofac Surg. Dec 1987;25(6):488-91. [Medline].

  12. Deblauwe BM, van der Waal I. Blood blisters of the oral mucosa (angina bullosa haemorrhagica). J Am Acad Dermatol. Aug 1994;31(2 Pt 2):341-4. [Medline].

  13. Edwards S, Wilkinson JD, Wojnarowska F. Angina bullosa haemorrhagica--a report of three cases and review of the literature. Clin Exp Dermatol. Nov 1990;15(6):422-4. [Medline].

  14. Giuliani M, Favia GF, Lajolo C, Miani CM. Angina bullosa haemorrhagica: presentation of eight new cases and a review of the literature. Oral Dis. Jan 2002;8(1):54-8. [Medline].

  15. Hopkins R, Walker DM. Oral blood blisters: angina bullosa haemorrhagica. Br J Oral Maxillofac Surg. Feb 1985;23(1):9-16. [Medline].

  16. Stephenson P, Lamey PJ, Scully C, Prime SS. Angina bullosa haemorrhagica: clinical and laboratory features in 30 patients. Oral Surg Oral Med Oral Pathol. May 1987;63(5):560-5. [Medline].

 
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A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone.
A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone. Image shows 24 hours after the initial presentation of angina bullosa hemorrhagica.
 
 
 
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