Endocarditis question

[Phloston]

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Do splinter haemorrhages in endocarditis only occur with left-sided valvular disease?

I had had the impression that small septic emboli from the tricuspid and pulmonic valves wouldn't be able to bypass the pulmonary circulation, and therefore we'd only see splinter haemorrhages with left-sided heart disease.

However now that I think of it, I believe I had seen a practice question some time ago on GT where an IV drug-user had fever, etc., with splinter haemorrhages of the nail beds, and then they asked which valve was affected. Normally I would have thought tricuspid (based on his IV drug-use status), but I instead selected mitral (most common overall) because of the splinter haemorrhages, and the answer was still tricuspid. I remember having been confused at the time because I'd think splinter haemorrhages would only be manifestations of left-sided valvular disease. Anyway, does anyone know?

 

[thinker]

You over analyzed that question! But a quick look on different medical websites says that Splinter Hemorrhages MAY be clots.. and two possible mechanisms of pathogenesis are provided, micro emboli and vasculitis. Thus it doesn't have to be specifically left-sided microemboli. I also read that they are not a specific finding and could be seen with psoriasis, rhomatoid, SLE, anti-phospholipid syndrome.. etc.

 

[Phloston]

Thanks for that.