Vazospastik Damar Hastalığı Zemininde Gelişen Refleks Sempatik Distrofi Sendromu: Olgu Sunumu ve Ayırıcı Tanı

Vasospastic disorders (VD) are group of vascular disease, present with episodic attacks of painful cyanosis and sometimes edema with absence of peripheral vascular diseases (PVD). Re- flex sympathetic dystrophy (RSD) is another disease characterized by vasomotor disorders, skin changes, edema and pain of limbs. We present a case of RSD accompanied with VD. 21 year old male patient presented to our department with painful edema and cyanosis of his right hand. He had trauma history 2 months ago. On physical examination, radial and ulnar arterial pulses were weak in room temperature and absent with cold exposure. On doopler USG, there was triphasical flow on upper extremity arteries at room temperature whereas monophasic flow after cold exposure. On angiography, there was absolute vasospasm on affected extremity arteries without any evidence of organic disorder. Iloprost and silostasol treatment started with extremity precaution of cold expo- sure and absolute elevation, but after 28 days, no effective results could obtained. On three-phase bone scan there weren"t any lesions concordant with RSD. The patient than admitted to rehabili- tation program with TENS. After 30 days, edema reduced significantly and pain were almost di- minished. After all, we decided the exact diagnosis as RSD. RSD is almost with VD, although VD doesn"t have to be with painful edema and trauma history. In addition, bone scans can be normal in RSD patients. So when deciding to diagnosis such as these patients, laboratory results can be mis- leading. Obtaining an exact history and sometimes treatment modalities can be guide for differen- tial diagnosis of these similar two entities.