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Image challenge
Woman with blue thumb
  1. So Sakamoto1,
  2. Yasuhiro Suyama2
  1. 1 Department of Emergency Medicine, Asahi General Hospital, Asahi, Japan
  2. 2 Division of Rheumatology, JR Tokyo Sogo Byoin, Tokyo, Japan
  1. Correspondence to Dr So Sakamoto, Emergency Medicine, Asahi General Hospital, Asahi 289-2511, Japan; sounet1980{at}gmail.com

https://doi.org/10.1136/emermed-2020-209683

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    Clinical introduction

    A previously healthy 86-year-old woman presented to the ED with sudden-onset pain and bruising in her left thumb, beginning several hours before. She denied any history of trauma or cold exposure. Her vital signs were stable. Physical examination revealed a subcutaneous haematoma and swelling with a normal sensation. D-dimer levels were not elevated (figure 1).

    Figure 1

    Bruising of the left thumb on admission.

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    Footnotes

    • Twitter @Sounet1980

    • Contributors SS: conception, design, acquisition of data and patient management; YS: interpretation of data. Furthermore, both authors have participated in writing the manuscript. Both authors have read and approved the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.