Bilateral Buerger's disease

Clinical History

The patient presented with toe necrosis. He had a one-year history of left leg and foot complaints during walking.

Imaging Findings

The patient presented with toe necrosis. He had a one-year history of left leg and foot complaints during walking. His bilateral pulses could not be palpated, but were positive on Doppler imaging. He smoked one pocket of cigarettes per day for the previous 4 years.

On angiography it was detected that the tibialis posterior, tibialis anterior and peroneal arteries were occluded bilaterally, but more markedly on the left side. The distal circulation was supplied by tortuous collaterals.

Discussion

Buerger's disease is an inflammatory obliterative vasculitis of unknown aetiology that involves small and medium sized arteries and veins. It involves the lower extremities (80%) more frequently than the upper extremities (10-20%) and is associated with thrombophlebitis. Although it may typically be encountered in 20-50 year old, heavy smoking males, women may also be affected. Diagnosis is best made histologically by punch biopsy, however occasionally biopsy itself can lead to ulceration. Differentiation from atherosclerosis may be difficult by angiography. Features favouring Buerger's disease rather than atherosclerosis are: presence of distal occlusions rather than proximal ones, absence of atherosclerotic changes in large proximal arteries, presence of normal areas between pathological segments and typically presence of bridging collaterals among occluded areas.

Differential Diagnosis List

Final Diagnosis

Bilateral Buerger's disease

URL:	https://www.eurorad.org/case/1772
DOI:	10.1594/EURORAD/CASE.1772
ISSN:	1563-4086