title: Lesson of the month 1: Splinter haemorrhages as a pointer to gastrointestinal malignancy.
abstract: A 58-year-old man was referred for review due to the finding of splinter haemorrhages and digital infarcts. Further questioning revealed a history of unintentional weight loss and calf pain. There were no other clinical features of endocarditis, and no clear cause for the splinter haemorrhages on initial investigations. The discovery of widespread thromboembolic disease prompted a search for malignancy and an eventual diagnosis of oesophageal adenocarcinoma. Splinter haemorrhages resolved with anticoagulation and directed treatment of the underlying malignancy. This case report reminds clinicians of the potentially broad differential diagnosis associated with this clinical sign.
authors.affiliation: Concord Hospital, Concord, Australia.
authors.forename: Cositha
authors.initials: C
authors.lastname: Santhakumar
authors.affiliation: Concord Hospital, Concord, Australia.
authors.forename: Chantal
authors.initials: C
authors.lastname: Faddoul
authors.affiliation: Auckland Hospital, New Zealand.
authors.forename: Russell
authors.initials: R
authors.lastname: Barker
authors.affiliation: Concord Hospital, Concord, Australia.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Facer
authors.affiliation: Concord Hospital, Sydney; senior lecturer, University of Sydney, Sydney, Australia sandhya.limaye@sswahs.nsw.gov.au.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Limaye
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D000925:Anticoagulants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000098:blood supply / Q000473:pathology
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents
keywords: Splinter haemorrhage; chemotherapy; clinical examination; hypercoaguability; malignancy; oesophageal ­adenocarcinoma