Splinter hemorrhage
Tiny blood clots running vertically under the nails.
Splinter hemorrhages are small blood clots that appear as vertical lines beneath the fingernails or toenails. They are not linked to any single disease and may occur in conditions such as subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus, rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, blood cancers, or injury. Initially, they look plum-colored, but within a couple of days they darken to brown or black.
In some cases—especially infective endocarditis—clots can break away from an infected heart valve and travel through the bloodstream. When one lodges in a finger, it can damage the tiny capillaries there, producing a splinter hemorrhage. Other causes include direct trauma to the nail, systemic vasculitis (inflammation of blood vessels throughout the body), or a fragment of cholesterol blocking a capillary in the finger. Even among patients with infective endocarditis, only about 1 in 10 will have splinter hemorrhages.
Quick Facts
- Differential
- subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome
Facts from the source article.
Lore & Background
Splinter hemorrhages are tiny blood clots that tend to run vertically under the nails. In certain conditions, in particular infective endocarditis, clots can migrate from the affected heart valve and find their way into various parts of the body; if this happens in the finger, it can cause damage to the capillaries resulting in a splinter hemorrhage. There are a number of other causes, including hitting the nail (trauma), a sign of inflammation in blood vessels all around the body (systemic vasculitis), or where a fragment of cholesterol has become lodged in the capillaries of the finger.
Reader's Guide
Splinter hemorrhages are notable as a clinical sign because they can be associated with several serious conditions, including subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus, rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, haematological malignancy, and trauma. However, they are not specific to any particular condition. Even if a patient does have infective endocarditis, roughly 1 in 10 patients have splinter hemorrhages. Their appearance—tiny blood clots running vertically under the nails—changes from plum-colored to brown or black over a couple of days. The underlying mechanism can involve migrating clots from a heart valve, systemic vasculitis, cholesterol emboli, or direct trauma.
Did You Know?
- At first they are usually plum-colored, but then darken to brown or black in a couple of days.
- Roughly 1 in 10 patients with infective endocarditis have splinter hemorrhages.
- They can be caused by trauma, systemic vasculitis, or a fragment of cholesterol lodged in finger capillaries.
Frequently Asked Questions
What is a splinter hemorrhage?
A splinter hemorrhage is a tiny blood clot that forms as a thin vertical line beneath the fingernail or toenail. It is not specific to one disease and can show up in a wide range of conditions, from trauma to autoimmune disorders.
What does a splinter hemorrhage look like when it first appears?
Fresh splinter hemorrhages present as small plum-colored streaks running lengthwise under the nail plate. Over the course of roughly two days, the color deepens to brown or black as the trapped blood breaks down.
Which conditions are commonly associated with splinter hemorrhages?
They have been reported in subacute infective endocarditis, scleroderma, trichinosis, systemic lupus erythematosus, rheumatoid arthritis, psoriatic nail disease, antiphospholipid syndrome, various blood cancers, and simple mechanical injury. Because so many different diagnoses can produce them, the sign alone never points to a single cause.
How do splinter hemorrhages relate to infective endocarditis specifically?
In endocarditis, small clots can detach from an infected heart valve and lodge in the tiny capillaries under the nail bed, producing the characteristic vertical line. Roughly one in ten patients with infective endocarditis will display this finding.
Why do clinicians consider splinter hemorrhages a useful but imperfect clue?
They are easy to spot on a quick nail exam and can prompt further cardiac or autoimmune workup, yet their presence is neither unique to one disease nor guaranteed to appear in a given condition. That makes them a helpful supporting sign rather than a standalone diagnostic marker.
More in Symptoms and Signs: Skin and Subcutaneous Tissue 1-16
Spotted an error? Know more?
Reader corrections go straight into our review queue. Suggest an edit · How this site is sourced