Buerger disease

Buerger disease (also known as thromboangiitis obliterans) is an obliterative arteritis found predominantly in heavy smokers.

Although it more commonly affects medium and small vessels of the lower extremities, upper extremity involvement may also be seen. Both arterial and venous involvement may occur.

Clinical presentation

Patients may initially present with nonspecific symptoms such as hand and foot claudication, which eventually progresses to ischemic ulceration. Biopsy is often necessary to make the diagnosis because the imaging appearance and symptoms overlap with those of atherosclerosis and other connective tissue diseases.

Radiographic features

Characteristic angiographic findings include extensive arterial occlusive disease accompanied by the development of corkscrew collateral vessels. More than one limb is usually affected with predominantly the lower limbs.

Corkscrew collateral vessels is not however pathognomonic for Buerger disease, as they may be seen in patients with connective tissue diseases

Intervening normal appearing arteries with sparing of the larger inflow vessels.

Differential diagnosis

• atherosclerosis
• connective tissue diseases
  • systemic lupus erythematosus (SLE)
  • mixed connective tissue disease
  • scleroderma