Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

1266 Raynaud’s Syndrome

■Episodic:

➣Coldness

➣Numbness

➣Pain

➣Cyanosis

➣Paresthesia

➣Almost always cold-induced

Signs & Symptoms

■Examination usually normal

■Fingertip ulceration seen in secondary Raynaud’s

■Decreased pulses at wrist suggestive of vasculitis, atherosclerosis or

other diagnosis

■Symptoms usually cannot be reproduced by immersion in cold water

■Capillary refill delayed after Allen’s test

tests

Blood

■Sedimentation rate and antinuclear antibody to determine collagen

vascular disease

Specific Diagnostic Tests

■Noninvasive vascular tests

➣Doppler ultrasound to exclude large vessel disease

➣Digital artery pressures

➣Decreased pressures at rest

proximal obstruction

secondary Raynaud’s or other cause

➣Decreased pressures with cold

➣Consistent with either primary or secondary Raynaud’s

■Arteriography

➣Used to determine etiology if noninvasive studies suggest proxi-

mal obstruction

➣Differentiates atherosclerosis from vasculitis

➣Intra-arterial vasodilators illustrate vasospastic component of

obstruction

differential diagnosis

■Livido reticularis

➣Asymptomatic irregular patchy purple discoloration of skin in

fishnet pattern

➣May be superimposed on Raynaud’s