28yo with increasing calf pain (350/1700)

A 28yo shipyard worker was admitted for pain in calf while at work which has been increasing
over the last 3m. There is no hx of HTN or DM but he is a smoker. Exam: loss of posterior tibial
and dorsalis pedis pulsation along with a non-healing ulcer at the base of the right 1st MTP joint.
What is the most probably dx?

a. Thromboangitis obliterans
b. Sciatica
c. DVT
d. Baker’s cyst
e. Embolus

































answer: A

Buerger's disease is a chronic disease characterised by segmental inflammation and thrombosis of the small- and medium-sized arteries and veins of both the peripheral upper and lower limbs. The thrombus leads to arterial ischaemia in the distal extremities and superficial thrombophlebitis, which may progress to gangrene and ulceration.

Diagnostic criteria

Diagnosis based on a list of criteria has been suggested, such as those of Shionoya:

• Age under 50 years.
• Current or recent history of tobacco use.
• Presence of infrapopliteal arterial occlusive disease indicated by claudication, pain at rest, ischaemic ulcers or gangrenes and documented by non-invasive vascular testing.
• Either upper-limb involvement or phlebitis migrans.
• Absence of atherosclerotic risk factors other than smoking, ie exclusion of:
  • Autoimmune diseases.
  • Hypercoagulable states.
  • Diabetes mellitus.
  • A proximal source of emboli by echocardiography or arteriography.