Diagnostic Considerations

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Acrocyanosis
Peripheral neuropathy
Ergotism
Livedo reticularis
Trauma
CREST (calcinosis cutis, Raynaud phenomenon, esophageal motility disorder, sclerodactyly, and telangiectasia) syndrome
Systemic lupus erythematosus
Rheumatoid vasculitis
Kawasaki disease
Wegener granulomatosis
Mixed connective-tissue disease
Antiphospholipid-antibody syndrome
Hyperhomocysteinemia with atherosclerosis
Popliteal artery entrapment syndrome
Repetitive vibratory equipment use
Hypothenar hammer syndrome

Differential Diagnoses

Workup

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Media Gallery

Feet of patient with thromboangiitis obliterans (Buerger disease). Note ischemic ulcers on distal portion of left great, second, and fifth toes. Although patient's right foot is normal in gross appearance, angiography demonstrated compromised arterial flow to both feet.
Superficial thrombophlebitis of great toe in patient with thromboangiitis obliterans (Buerger disease).
Tobacco smoke stains on male patient's fingers suggest diagnosis of thromboangiitis obliterans (Buerger disease). Patient presented with small, painful ulcers on tips of thumb and ring finger.
Lower-extremity arteriogram of peroneal and tibial arteries of patient with thromboangiitis obliterans (Buerger disease) demonstrates classic findings of multiple small and medium-sized arterial occlusions with formation of compensatory "corkscrew collaterals."

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Table 1. Scoring System for Diagnosis of Thromboangiitis Obliterans ^[11]

Positive Criterion		Positive Points
Age at onset	< 30 y (+2) 30-40 y (+1)
Foot intermittent claudication	Present (+2) By history only (+1)
Upper extremity	Symptomatic (+2) Asymptomatic (+1)
Migrating superficial thrombophlebitis	Present (+2) By history only (+1)
Raynaud phenomenon	Present (+2) By history only (+1)
Angiography; biopsy	If typical, both (+2) Either(+1)
Negative Criterion			Negative Points
Age at onset	45-50 y (−1) >50 y (−2)
Sex; smoking	Female (−1) Nonsmoker (−2)
Location	Single limb (−1) No lower extremity involved (−2)
Absent pulses	Brachial (−1) Femoral (−2)
Arteriosclerosis, diabetes, hypertension, hyperlipidemia	Discovered 5.1-10 y after diagnosis (−1) Discovered 2.1-5 y later (−2)

Table 2. Numerical Scores Defining Probability of Diagnosis of Thromboangiitis Obliterans

Score	Probability of Diagnosis
0-1	Diagnosis excluded
2-3	Diagnosis suspected (low probability)
4-5	Diagnosis probable (medium probability)
≥6	Diagnosis definite (high probability)

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Author

Naiem Nassiri, MD, RPVI Associate Professor of Surgery (Vascular), Department of Surgery, Division of Vascular and Endovascular Surgery, Yale University School of Medicine; Chief, Vascular and Endovascular Surgery, Department of Surgery, Section of Vascular Surgery, VA Connecticut Healthcare System; Director, Vascular Malformations Program (VaMP), Yale New Haven Hospital

Naiem Nassiri, MD, RPVI is a member of the following medical societies: American College of Radiology, Association for Clinical and Translational Science, Eastern Vascular Society, International Society for the Study of Vascular Anomalies, International Society of Endovascular Specialists, International Union of Angiology, New England Society for Vascular Surgery, Society for Clinical Vascular Surgery, Society for Vascular Surgery

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD, FACS Professor and Chief, Division of Vascular and Endovascular Surgery, Gonda (Goldschmied) Vascular Center, University of California, Los Angeles, David Geffen School of Medicine

Vincent Lopez Rowe, MD, FACS is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Society of Black Academic Surgeons, Society of Black Vascular Surgeons, Southern California Vascular Surgical Society, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Matthew Carpenter, MD Program Director, Department of Internal Medicine, Department of Internal Medicine, Keesler Medical Center; Assistant Clinical Professor, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine