Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes are small red tender nodules located in the fingertip and at the proximal end and the lateral edge of the nails. They grow over a period of several days to weeks. Janeway lesions are little different from from osler's nodes because they often appeared as non-tender hemorrhagic or nodular lesions on the palms and feet. Clinically both are cardinal manifestations of subacute bacterial endocarditis.

At the beginning of these nodes, patients might feel nerve pain or neurological pain. Although these nodes originally considered to be derived via immune system response. It is proposed that the microembolization along with micro-abscess is occurred due to vasculitis triggered by immunomodified hypersensitivity. Osler's nodes may appear at any time during subacute cutaneous lupus erythematosus and may take several hours to a few days to settle down. They may also be due to infective endocarditis.

Osler's nodes usually ranges from 0.5cm to 1cm and appear as painful brownish or reddish subcutaneous papules on feet, finger tips, toes and palms. Many researchers are still trying to find out exact underlying pathophysiology that triggers such kinds of nodes. However, current clinical data suggests that these nodes are occurred due to immune system hypersensitivity.

Osler's nodes Pictures


Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment


Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes Symptoms


Physically, osler's nodes are quite similar to janeway lesions so, it is difficult to differentiate them without examining further via microscopical or histological examination. However, some commonly observed features of osler's nodes during clinical practice are

  • Nodules like appearance at finger tips, palms, toes and feet
  • Reddish brown in color
  • Painful
  • Itching
  • Feeling of tenderness
  • Slightly raised with pale surface

Osler's nodes Causes


Exact etiological factors that drive the whole process are still not fully understood but many immunologist believe that infective endocarditis, subacute cutaneous lupus erythematosus and gonococcal infection are strongly associated with such kind of nodes and lesions. Hypersensitive immune system is another factor that triggers such phenomenon.

Osler's nodes Treatment


Osler's nodes usually last several hours to a few days to settle down. However, root cause treatment is necessary otherwise they might appear again at some point. If osler's nodes appear due to infective process then then primary problem should be treated accordingly to avoid further progression. Similarly, if immune system is main culprit then anti-allergic drugs should be used to reduce hypersensitivity of immune system.
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Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaques are cholesterol emboli found at the bifurcation of the retinal arteries. The source of these emboli is generally the heart or carotid arteries. They are usually unilateral and occur in elderly patients with advanced atherosclerosis. Symptoms of fugitive alteration of vision may accompany these emboli.

Light yellow deposit usually stick to the peripheral artery at the bifurcation of a peripheral arteriole due to which they cause occlusion of branch retinal artery. This often appears larger than the artery where it is and sometimes you can even see it during migrating down. Migration can be facilitated by lightly massaging the eyeball. It is an arterial cholesterol embolism from an atheromatous plaque ulcer in a proximal artery, usually the internal carotid artery.

Usually embolism associated with retinal artery are often termed as hollenhorst plaque. Due to insignificant symptoms they often diagnosed during routine checkups but appearance of several emboli over time in the arterial tree gives temporary vision loss for seconds at a time. Loss of vision occurs because a temporary artery occlusion occurs, followed by a break of embolism, the components are taken down into the fine capillary system. Larger embolism can be lodged in a vessel permanently and cause massive ischemia in the part of the retina, with permanent loss. In some cases, larger emboli settle down in retinal artery with no obvious symptom in general. This is usually due to the blood flowing around the embolus and continuing retinal tissue supply.

Hollenhorst plaque Images


Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Symptoms


Usually patient remains asymptomatic in case of small emboli. It is often diagnosed during routing examination of eye. If the large sized emboli deposit in retinal artery then sudden vision loss just for few second or blurry vision for few seconds might be a major symptom of Hollenhorst plaque. Usually white color deposits occur due to deposition of calcium while yellowish appearance reveals the deposition of cholesterol.

Hollenhorst plaqueCauses


There number of causes that trigger hollenhorst plaque. These are diabetes mellitus, atherosclerosis, hypercholesterolemia, blood thickening, geriatric patients. However, about 60% cases of hollenhorst plaque are mainly due to diabetes mellitus so, patients having diabetes are more prone get hollenhorst plaque.

Hollenhorst plaque Treatment


Hollenhorst plaque is alarming condition because patient is at high risk to have hemorrhage, stroke, myocardial infarction, circulatory disorder etc. A prompt strategy to minimize such problems is usage of blood thinning agents like aspirin, low molecular weight heparin and anti-clotting agents.  Similarly, if patient is diabetic he must control his/her diabetes by using insulin or other anti-diabetic agents like metformin etc.

Hollenhorst plaque ICD-10


Following code is used for Hollenhorst plaque in ICD-10

H34.219--Partial retinal artery occlusion, unspecified eye--Billable
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