Splinter hemorrhage

Splinter hemorrhage on a nail of the little finger.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Splinter hemorrhages (or haemorrhages) are tiny lines that run vertically under nails. Splinter hemorrhage is a nonspecific finding and can be associated with subacute bacterial endocarditis, scleroderma, trichinosis, Systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome, and trauma. At first they are usually plum-colored, but then darken to brown or black in a couple of days. In certain conditions (in particular, infective endocarditis), clots can migrate from the affected heart valve and find their way into various parts of the body. If this happens in the finger, it can cause damage to the capillaries resulting in a splinter hemorrhage.

Sensitivity and Specificity of Splinter Hemorrhages in the Diagnosis of Endocarditis

The presence of splinter hemorrhages is not sensitive but is a fairly specific finding the diagnosis of endocarditis. Only one in six patients with endocarditis will have splinter hemorrhages. Therefore the absence of splinter hemorrhages does not exclude endocarditis. If there is a clinical suspicion of endocarditis and splinter hemorrhages are observed, then this is likely a fairly specific finding for endocarditis.

Causes

• Cholesterol embolization
• Endocarditis
• Psoriatic nails
• Rheumatoid arthritis
• Scleroderma
• Systemic lupus erythematosus (SLE)
• Trauma
• Trichinosis
• Vasculitis