Thrombangiitis obliterans (Burger's disease)

    Thrombangiitis obliterans (Burger’s disease) is a vanishingly rare disease in USA, but is still a problem in some developing countries.
    Clinical features of the disease include:

    • Very strong association with smoking, especially unprocessed and unfiltered tobacco products.
    • More common in males than females
    • Painful violaceous lesions on distal extreminties, especially fingers and toes.
    • Ulceration.
    • Sensation of coldness.
    • Resolution after cessation of smoking
    • Visceral involvement exceptionally rare but can occur.

    Histological features include:

    • Involvement of small to medium sized arteries and (rarely) veins
    • Intravascular thrombosis.
    • Mixed inflammation infiltrate in vessel wall with numerous neutrophils
    • Intravascular abscesses can be associated with intravascular thrombi or be present within a vessel wall
    • Preserved internal elastic lamina
    • Intravascular thrombi recanalize during resolution

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