Antiphospholipid syndrome physical examination: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(13 intermediate revisions by one other user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Antiphospholipid syndrome}}
{{Antiphospholipid syndrome}}
{{CMG}}{{AE}}{{FT}}
{{CMG}}; {{AE}}{{FT}}


==Overview==
==Overview==
Physical examination shows no pathognomonic physical findings of APS; however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations.
Physical examination shows no pathognomonic physical findings of antiphospholipid syndrome (APS); however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations.


==Physical Examination==
==Physical Examination==
Line 14: Line 14:
===Vital Signs===
===Vital Signs===


*Low-grade fever may be present in case of infectious cause of APS>\.
*Low-grade fever may be present in case of infectious cause of APS.


===Cutaneous manifestations===
===Cutaneous manifestations===
Skin examination of patients with APS is usually positive for:
Skin examination of patients with APS is usually positive for:<ref name="pmid11953980">{{cite journal| author=Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT et al.| title=Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. | journal=Arthritis Rheum | year= 2002 | volume= 46 | issue= 4 | pages= 1019-27 | pmid=11953980 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11953980  }} </ref><ref name="pmid20822807">{{cite journal| author=Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA| title=Antiphospholipid syndrome. | journal=Lancet | year= 2010 | volume= 376 | issue= 9751 | pages= 1498-509 | pmid=20822807 | doi=10.1016/S0140-6736(10)60709-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20822807  }} </ref><ref name="pmid27334977">{{cite journal| author=Negrini S, Pappalardo F, Murdaca G, Indiveri F, Puppo F| title=The antiphospholipid syndrome: from pathophysiology to treatment. | journal=Clin Exp Med | year= 2017 | volume= 17 | issue= 3 | pages= 257-267 | pmid=27334977 | doi=10.1007/s10238-016-0430-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27334977  }} </ref>
*Venous thromboembolism
*[[Venous thromboembolism]]
*Livedo reticularis  
*[[Livedoid vasculitis|Livedo reticularis]]
*Purpura
*[[Purpura]]
*Superficial thrombophelibitis
*Superficial thrombophelibitis
*Leg ulcers
*Leg ulcers
*Splinter hemorrhages
*[[Splinter hemorrhage|Splinter]] [[Bleeding|hemorrhages]]
*Gangrene of the distal extremities
*[[Gangrene]] of the distal extremities
*Leg swelling
*Leg swelling


===HEENT===
===HEENT===
Abnormal fundoscopic examination findings:
Abnormal fundoscopic examination findings:<ref name="pmid17101948">{{cite journal| author=Tektonidou MG, Varsou N, Kotoulas G, Antoniou A, Moutsopoulos HM| title=Cognitive deficits in patients with antiphospholipid syndrome: association with clinical, laboratory, and brain magnetic resonance imaging findings. | journal=Arch Intern Med | year= 2006 | volume= 166 | issue= 20 | pages= 2278-84 | pmid=17101948 | doi=10.1001/archinte.166.20.2278 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17101948  }} </ref>
*Retinal artery occlusion findings
*[[Retinal]] artery occlusion findings
*Retinal vein thrombosis findings
*Retinal vein [[thrombosis]] findings


===Neck===
===Neck===
* Neck examination of patients with APS is usually normal.
* Neck examination of patients with APS can show [[lymphadenopathy]].
===Lungs===
===Lungs===
Pulmonary examination of patients with APS may show the following findings:
Pulmonary examination of patients with APS may show the following findings:
*Tachypnea in case of pulmonary embolism.
*[[Tachypnea]] in case of pulmonary embolism.
===Heart===
===Heart===
* Cardiovascular examination of patients with APS shows findings consistent with heart valve disease.
* Cardiovascular examination of patients with APS shows findings consistent with
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope.
* Heart valve disease  
* [[Pericarditis]]


===Abdomen===
===Abdomen===
* [[Hepatomegaly]]<ref name="pmid25641203">{{cite journal| author=Abreu MM, Danowski A, Wahl DG, Amigo MC, Tektonidou M, Pacheco MS et al.| title=The relevance of "non-criteria" clinical manifestations of antiphospholipid syndrome: 14th International Congress on Antiphospholipid Antibodies Technical Task Force Report on Antiphospholipid Syndrome Clinical Features. | journal=Autoimmun Rev | year= 2015 | volume= 14 | issue= 5 | pages= 401-14 | pmid=25641203 | doi=10.1016/j.autrev.2015.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25641203  }} </ref>
* [[Splenomegaly]]
*[[Abdominal tenderness]] in the lower abdominal quadrant in case of miscarriage or fetal loss.
*[[Abdominal tenderness]] in the lower abdominal quadrant in case of miscarriage or fetal loss.
*[[Rebound tenderness]]  
*[[Rebound tenderness]]  
Line 53: Line 57:


===Neuromuscular===
===Neuromuscular===
* Neurological exam findings consistent with stroke or transient ischemic attack.
* Neurological exam findings consistent with [[stroke]] or [[Transient ischemic attack|transient]] ischemic attack.<ref name="pmid28769114">{{cite journal| author=Sciascia S, Amigo MC, Roccatello D, Khamashta M| title=Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances. | journal=Nat Rev Rheumatol | year= 2017 | volume= 13 | issue= 9 | pages= 548-560 | pmid=28769114 | doi=10.1038/nrrheum.2017.124 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28769114  }} </ref>
* Migraine
* [[Migraine]]
* Vascular dementia
* [[Multi-infarct dementia|Vascular dementia]]
* Pre-eclampsia or eclampsia
* [[Pre-eclampsia]] or [[eclampsia]]


==References==
==References==

Latest revision as of 20:26, 24 April 2018

Antiphospholipid syndrome Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Antiphospholipid syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Antiphospholipid syndrome physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Antiphospholipid syndrome physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Antiphospholipid syndrome physical examination

CDC on Antiphospholipid syndrome physical examination

Antiphospholipid syndrome physical examination in the news

Blogs on Antiphospholipid syndrome physical examination

Directions to Hospitals Treating Antiphospholipid syndrome

Risk calculators and risk factors for Antiphospholipid syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Physical examination shows no pathognomonic physical findings of antiphospholipid syndrome (APS); however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations.

Physical Examination

Physical examination shows no pathognomonic physical findings of APS; however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations.

Appearance of the Patient

  • Patients with APS usually appear normal.

Vital Signs

  • Low-grade fever may be present in case of infectious cause of APS.

Cutaneous manifestations

Skin examination of patients with APS is usually positive for:[1][2][3]

HEENT

Abnormal fundoscopic examination findings:[4]

Neck

Lungs

Pulmonary examination of patients with APS may show the following findings:

Heart

  • Cardiovascular examination of patients with APS shows findings consistent with
  • Heart valve disease
  • Pericarditis

Abdomen

Back

  • Back examination of patients with APS is usually normal.

Genitourinary

  • Genitourinary examination of patients with APS is usually normal.

Neuromuscular

References

  1. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT; et al. (2002). "Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients". Arthritis Rheum. 46 (4): 1019–27. PMID 11953980.
  2. Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA (2010). "Antiphospholipid syndrome". Lancet. 376 (9751): 1498–509. doi:10.1016/S0140-6736(10)60709-X. PMID 20822807.
  3. Negrini S, Pappalardo F, Murdaca G, Indiveri F, Puppo F (2017). "The antiphospholipid syndrome: from pathophysiology to treatment". Clin Exp Med. 17 (3): 257–267. doi:10.1007/s10238-016-0430-5. PMID 27334977.
  4. Tektonidou MG, Varsou N, Kotoulas G, Antoniou A, Moutsopoulos HM (2006). "Cognitive deficits in patients with antiphospholipid syndrome: association with clinical, laboratory, and brain magnetic resonance imaging findings". Arch Intern Med. 166 (20): 2278–84. doi:10.1001/archinte.166.20.2278. PMID 17101948.
  5. Abreu MM, Danowski A, Wahl DG, Amigo MC, Tektonidou M, Pacheco MS; et al. (2015). "The relevance of "non-criteria" clinical manifestations of antiphospholipid syndrome: 14th International Congress on Antiphospholipid Antibodies Technical Task Force Report on Antiphospholipid Syndrome Clinical Features". Autoimmun Rev. 14 (5): 401–14. doi:10.1016/j.autrev.2015.01.002. PMID 25641203.
  6. Sciascia S, Amigo MC, Roccatello D, Khamashta M (2017). "Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances". Nat Rev Rheumatol. 13 (9): 548–560. doi:10.1038/nrrheum.2017.124. PMID 28769114.