Tendon xanthomata

173 Tendon xanthomata



Instruction


Look at this patient’s hands.



Salient features



History




• Family history of hyperlipidaemia


• History of premature coronary artery disease.



Examination




• Tendon xanthomata seen on the extensor tendons and becoming more prominent when the patient clenches his fist (Fig. 173.1B)


image

Fig. 173.1 Clinical manifestations of hyperlipidaemia (A) Achilles tendon xanthoma (heterozygous familial hypercholesterolaemia). (B) Tendon xanthomata on dorsum of hand (heterozygous familial hypercholesterolaemia). (C) Subperiosteal xanthomata (heterozygous familial hypercholesterolaemia). (D) Planar xanthoma in antecubital fossa (homozygous familial hypercholesterolaemia). (E) Striate palmar xanthomata (type III hyperlipoproteinaemia). (F) Tuberoeruptive xanthomata on elbow and extensor surface of arm (type III hyperlipoproteinaemia). (G) Milky plasma from patient with acute abdominal pain (severe hypertriglyceridaemia). (H) Eruptive xanthomata on extensor surface of forearm (severe hypertriglyceridaemia).


(With permission from Durrington 2003.)


Proceed as follows:



• Look at other tendons, particularly the patellar and Achilles tendon (Fig. 173.1A)


• Look at the eyes for xanthelasmata (see Fig. 170.1) and corneal arcus


• Tell the examiner that you would like to:


• check fasting lipids, in particular for an increase in cholesterol level

• screen family members for hypercholesterolaemia

Related posts:

  1. Permanent cardiac pacemaker/implantable cardioverter-defibrillator
  2. Cauda equina syndrome
  3. Dermatomyositis
  4. Arteriovenous fistula

Stay updated, free articles. Join our Telegram channel
Tags:
Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Tendon xanthomata

Full access? Get Clinical Tree
Get Clinical Tree app for offline access