Splinter hemorrhage
Tiny blood clots under nails, linked to various conditions.
Last updated
Splinter hemorrhages are small blood clots that appear as vertical lines beneath the nails. Initially plum-colored, they darken to brown or black within a few days. These marks are not unique to any one disease and may be linked to several conditions, including subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus, rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, hematological malignancy, and trauma.
In infective endocarditis, clots can travel from an infected heart valve through the bloodstream. If one lodges in a finger, it can damage the capillaries there, producing a splinter hemorrhage. Other causes include direct nail injury (trauma), systemic vasculitis (inflammation of blood vessels throughout the body), or a fragment of cholesterol blocking capillaries in the finger. Even among patients with infective endocarditis, only about one in ten will have splinter hemorrhages.
Quick Facts
- Appearance
- Plum-colored, darkening to brown or black in a couple of days
- Mechanism in endocarditis
- Clots migrate from affected heart valve to finger capillaries
- Other causes
- Trauma
- systemic vasculitis
- cholesterol fragment lodging
- Prevalence in endocarditis
- Roughly 1 in 10 patients have splinter hemorrhages
Facts from the source article.
Lore & Background
Splinter hemorrhages are small, vertically oriented blood clots that appear under the nails. Initially plum-colored, they darken to brown or black within a couple of days. They are not specific to any single condition, but are associated with a range of disorders including subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, haematological malignancy, and trauma.
Reader's Guide
Splinter hemorrhages serve as a clinical sign that can prompt investigation into underlying systemic conditions. In infective endocarditis, clots from the affected heart valve may migrate to finger capillaries, causing damage and resulting in splinter hemorrhages. However, only about 1 in 10 patients with endocarditis exhibit this sign. Other causes include direct trauma, systemic vasculitis (inflammation of blood vessels throughout the body), or lodging of cholesterol fragments in finger capillaries.
Because splinter hemorrhages are not specific to any one condition, their presence requires careful clinical correlation with other symptoms and diagnostic tests. Their significance lies in their role as a visible clue that may point to serious underlying disease, though they can also result from benign trauma. The differential diagnosis is broad, and the finding alone does not confirm any particular illness.
More in Symptoms and signs: Skin and subcutaneous tissue
Sources
Compiled from Wikipedia and the sources listed below. Text from Wikipedia is available under CC BY-SA 4.0; this entry is adapted from it.
- Wikipedia: Splinter hemorrhage (CC BY-SA 4.0).
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