Splinter hemorrhage

Overview
Splinter hemorrhages (or haemorrhages) are tiny lines that run vertically under nails. Splinter hemorrhage is a nonspecific finding and can be associated with subacute bacterial endocarditis, scleroderma, trichinosis, Systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, and trauma.

Pathophysiology
In certain conditions (in particular, infective endocarditis), clots can migrate from the affected heart valve and find their way into various parts of the body. If this happens in the finger, it can cause damage to the capillaries resulting in a splinter hemorrhage.

Natural History, Complications and Prognosis
Initially splinter hemorrhages are plum-colored, but they then darken to a brown or black color in several days.

Sensitivity and Specificity of Splinter Hemorrhages in the Diagnosis of Endocarditis
The presence of splinter hemorrhages is not sensitive but is a fairly specific finding the diagnosis of endocarditis. Only one in six patients with endocarditis will have splinter hemorrhages. Therefore the absence of splinter hemorrhages does not exclude endocarditis. If there is a clinical suspicion of endocarditis and splinter hemorrhages are observed, then this is likely a fairly specific finding for endocarditis.

Causes of Splinter Hemorrhages

 * Cholesterol embolization
 * Endocarditis
 * Psoriatic nails
 * Rheumatoid arthritis
 * Scleroderma
 * Systemic lupus erythematosus (SLE)
 * Trauma
 * Trichinosis
 * Vasculitis