[Unusual manifestation of varicose veins: a 69-year-old patient with finger pain].

Abstract

Varicose veins of the hand and fingers are an unusual presentation and are little known in the consultation as a differential diagnosis of hand complaints.A 69-year-old female patient, who had worked as a cleaner for a long time, presented to our practice because of pain in the palm of her hand. She had been observing bluish changes on the volar side of the hand and fingers for more than 10 years. A few days ago, painful nodules had appeared on the middle and ring fingers of her right hand.The clinical examination revealed the suspicion of an extensive palmar hand and finger varicosis on both sides, with indurated nodules on D3 and 4 on the right, which was confirmed by duplex sonography as partially thrombosed finger varices. The varicose vein thrombosis developed under anticoagulation with Rivaroxaban 20mg, which was indicated due to atrial fibrillation.Analgesia with 600-1200mg Ibuprofen led to a rapid regression of pain. Remedial treatment options for finger varicosis such as sclerotherapy, ablative procedures or surgical excision were discussed as experimental approaches and were not desired by the patient.Unlike in the lower extremities, hands and fingers are less well-known manifestations of varicosis. Finger varicosis usually appears asymptomatically, but can cause pain if finger hematomas and variceal thrombosis occur. Varicose veins of the hand occur more frequently in aged patients and are favored by mechanical stress. Treatment is usually symptomatic.