(BMJ)—An otherwise healthy 86-year-old woman presented with sudden-onset L thumb pain and bruising that began several hours earlier. She denied hx of trauma, cold exposure, or emotional stress. Exam: vital signs, WNL; subcutaneous hematoma with swelling; normal sensation, normal pulses; d-dimer, WNL. What’s the dx?
Buerger disease
Raynaud phenomenon
Acute limb ischemia
Gardner-Diamond syndrome
Achenbach syndrome
You are correct. Achenbach syndrome, also called paroxysmal finger hematoma, is an idiopathic condition characterized by paroxysmal subcutaneous hematomas in the fingers, palms, or toes, without any triggers. It initially presents as a sudden localized sensation of pain and numbness, followed by edema or bruising, and disappears after a few days. This abrupt-onset and frightening condition is more common in women >50 years old.

The patient’s normal pulse, lack of cold exposure, and lack of emotional stress ruled out the other options. Her bluish discoloration and edema subsided spontaneously within a few days.

Emergency Medicine Journal 2021;38:262-284