Cardiology>>>>>Peripheral Vascular Disease
Question 6#

A 15-year-old man presents to the clinic accompanied by his mother for evaluation of “red hands.” He earned money last winter clearing sidewalks of snow and plans to do so again in the upcoming weeks. He reports developing red discoloration of his hands after returning home from the cold. The discoloration persisted for a few minutes until his hands were rewarmed. He denies weakness, paresthesia, pain, or skin lesions. He is otherwise healthy. At the time of consultation, inspection of his hands is unrevealing. Radial and ulnar pulses are 2+/2 bilaterally. The Allen test and reverse Allen test reveal return of color to the hands in 7 seconds bilaterally. His mother reports that she and her mother both have Raynaud phenomenon. The patient’s mother expresses concern that her son may have systemic lupus and she requests further testing.

What is the most likely diagnosis?

A. Raynaud disease
B. Raynaud phenomenon
C. Normal physiologic cold response
D. Acrocyanosis
E. Thermal injury

Correct Answer is C

Comment:

Normal physiologic cold response. This patient is exhibiting a normal response to prolonged exposure to cold. The diagnosis of Raynaud phenomenon is clinical and includes the presence of pallor or acrocyanosis and pain with cold exposure. Redness of the hands with warming after prolonged cold exposure, without concomitant pain, may be a normal response in a healthy young individual. He should be counseled to wear gloves and report any change in his symptoms, as his family history does predispose him to development of Raynaud phenomenon.

Reference:

Wigley FM. Raynaud’s phenomenon. N Engl J Med. 2002;347:1001–1008.