Buergers Disease, thoracic

outlet syndrome & Aneurysm

Buergers Disease
• Buerger's disease is a rare disease of the arteries and veins in
the arms and legs. In Buerger's disease — also called
thromboangiitis obliterans — your blood vessels become
inflamed, swell and can become blocked with blood clots
(thrombi).
Pathophysiology
• There are characteristic pathologic findings of
acute inflammation and thrombosis (clotting)
of arteries and veins of the hands and feet (the lower limbs
being more common). The mechanisms underlying Buerger's
disease are still largely unknown, but smoking and tobacco
consumption are major factors associated with it. It has been
suggested that the tobacco may trigger an immune response in
susceptible persons or it may unmask a clotting defect, either of
which could incite an inflammatory reaction of the vessel wall.
This eventually leads to vasculitis and ischemic changes
in distal parts of limbs.
Risk factors
• The most potent risk factor in the development of Buerger's disease is
tobacco smoking. Other risk factors include male sex, rickettsial infection,
South Asian or Middle Eastern descent, age between 20 - 45 years and a
medical history of Raynaud's disease or autoimmune disease.
Symptoms of Buerger’s disease

• Cramping in the calf with exercise.

• Pain in your arms, hands, legs, fingers, or toes.
• Pale, red, or blue hands and feet.
• Cold hands and feet.
• Numbness or tingling in your limbs.
• Skin ulcers or wounds that don’t heal on your fingers and toes.
Diagnosing Buerger’s disease

• Buerger’s disease diagnostic tests may include:

• A complete physical exam that checks your pulse.
• Ultrasound — uses sound waves to create pictures of the blood
flow through your arms and legs.
• Angiogram — uses an x-ray and contrast material to show
blockages in your blood vessels.
• Computed tomography angiogram (CTA) — uses cross-
sectional x-rays and a computer to create detailed 3D images.
Buerger’s Disease Treatment

• The most effective way to keep the disease from getting worse is to
stop smoking and using tobacco products.
• You must also avoid exposure to cold temperatures and practice
proper hand and foot care.
• Other treatments — that may be less effective — can include:
• Medicines to open (dilate) your blood vessels, or blood thinners to
prevent blood clots.
• Surgery to restore proper blood flow.
• Amputation of gangrenous fingers or toes.
Thoracic outlet syndrome
• Thoracic outlet syndrome is a group of disorders that occur
when blood vessels or nerves in the space between your
collarbone and your first rib (thoracic outlet) are compressed.
This can cause pain in your shoulders and neck and numbness
in your fingers.
Symptoms

• Neurogenic (neurological) thoracic outlet syndrome. This most

common type of thoracic outlet syndrome is characterized by compression
of the brachial plexus. The brachial plexus is a network of nerves that
come from your spinal cord and control muscle movements and sensation
in your shoulder, arm and hand.
• Vascular thoracic outlet syndrome. This type of thoracic outlet
syndrome occurs when one or more of the veins (venous thoracic outlet
syndrome) or arteries (arterial thoracic outlet syndrome) under the
collarbone (clavicle) are compressed.
• Nonspecific-type thoracic outlet syndrome. This type is also called
disputed thoracic outlet syndrome. Some doctors don't believe it exists,
while others say it's a common disorder. People with nonspecific-type
thoracic outlet syndrome have chronic pain in the area of the thoracic
outlet that worsens with activity, but a specific cause of the pain can't be
determined.
• Thoracic outlet syndrome symptoms can vary, depending on
which structures are compressed. When nerves are
compressed, signs and symptoms of neurological thoracic
outlet syndrome include:
• Muscle wasting in the fleshy base of your thumb (Gilliatt-
Sumner hand)
• Numbness or tingling in your arm or fingers
• Pain or aches in your neck, shoulder or hand
• Weakening grip
Aneurysm
• An aneurysm refers to a weakening of an artery wall that creates a bulge,
or distention, of the artery. Most aneurysms do not show symptoms and
are not dangerous. However, at their most severe stage, some can rupture,
leading to life-threatening internal bleeding.
Risk factors
• High blood pressure, genetics, and smoking are a few of the risk
factors for having an aneurysm. A brain or aortic aneurysm can be serious
and even deadly.
Signs and symptoms
• Sudden, extremely severe headache.
• Nausea and vomiting.
• Stiff neck.
• Blurred or double vision.
• Sensitivity to light.
• Seizure.
• A drooping eyelid.
• Loss of consciousness.
Diagnosis
• If you experience a sudden, severe headache or other
symptoms possibly related to a ruptured aneurysm, you'll be
given a test or series of tests to determine whether you've had
bleeding into the space between your brain and surrounding
tissues (subarachnoid hemorrhage) or possibly another type of
stroke.
•
If you show symptoms of an unruptured brain aneurysm — such
as pain behind the eye, changes in vision or double vision —
you will also undergo some tests to identify the offending
aneurysm.
• Computerized tomography (CT)
• Cerebrospinal fluid test
• Magnetic resonance imaging (MRI)
• Cerebral angiogram
Treatment
• Surgical clipping
• Endovascular coiling
• Flow diverters