BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1997 (Published 20 May 2009) Cite this as: BMJ 2009;338:b1997
  1. Haroon Siddique, specialist registrar,
  2. Ananth Nayak, specialist registrar,
  3. Baldev Singh, consultant,
  4. Varadarajan Baskar, consultant
  1. 1Wolverhampton Diabetes Centre, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton WV10 0QP
  1. haroon.siddique{at}rwh-tr.nhs.uk

    A 65 year old man with diabetes and established microvascular complications presented with arm pain and splinter haemorrhages in his left hand. Multiple blood cultures and an echocardiogram excluded infective endocarditis and a vasculitic screen was negative. A computed tomographic angiogram showed marked atheromas around the origin of the left subclavian artery with occlusive thrombus and atheromas in other vascular trees. His risk factors were addressed and he had a good clinical response to warfarin. A rare sign like splinter haemorrhage can be caused by a common condition such as atherosclerosis. Aggressive lipid management and prevention of embolic events is the mainstay of treatment.


    Cite this as: BMJ 2009;338:b1997


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