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Finger Pain 2

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A man in his 60s with ESRD presents to the ED for 4 days of left ring finger pain and discoloration.  He denies any fever, injury or other complaint.

Vital Signs & Physical Exam:

Vital signs are normal.   Physical exam is otherwise normal except for image below and dialysis shunt in other arm.  finger is tender and slightly cool but not swollen.  The following finding is seen

Initial Diagnostic Testing:

  • EKG: normal
  • Labs: WBC normal, CKD at baseline
  • XR: normal

What is the most likely diagnosis:

  • A) calciphylaxis
  • B) vascular embolism
  • C) rheumatologic condition
  • D) felon

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DIAGNOSIS, 1-MINUTE CONSULT and CASE CONCLUSION:

What is the most likely diagnosis:

  • B) vascular embolism: typically affects a single digit.  Typically needs same workup as a stroke patient.

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CASE CONCLUSION: Pulse ox on that finger maxed at 74% while it was 98% on the opposite ring finger

CASE LESSONS:

  • A) calciphylaxis: often occurs in renal failure with high Ca-PO4 product and can cause rash and pain but typically is diffuse often with superficial scabs/scales
  • B)
  • C) rheumatologic condition: usually all digits involved if vasculitic ischemia not just one
  • D) felon: usually pink, warm and swollen with normal pulse ox
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