A 24-year-old male smoker presents with claudication of both calves and recurrent small painful ulcers on his toes. Angiography shows segmental occlusions of the distal tibial and plantar arteries with normal proximal vessels and corkscrew collaterals. ESR and CRP are normal. Which additional feature would most strongly support the diagnosis?

• A Elevated serum homocysteine
• B Superficial migratory thrombophlebitis ✓
• C Absent femoral pulses
• D Calcification of the tibial arteries on plain radiograph

Explanation

Thromboangiitis obliterans (Buerger disease) is an inflammatory, non-atherosclerotic occlusive disease of small and medium vessels of young heavy smokers. Migratory superficial thrombophlebitis occurs in up to 40 percent of patients and is a classic associated feature. Calcified vessels indicate atherosclerosis, absent femoral pulses suggest proximal large vessel disease, and hyperhomocysteinemia causes premature atherosclerosis rather than corkscrew collaterals with normal inflammatory markers.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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