A 58-year-old diabetic man with end-stage renal disease on hemodialysis presents with a non-healing ulcer on his left foot and progressive toe gangrene. Vital signs show BP 158/92 mmHg, HR 88/min, and normal SpO2. Pedal pulses are diminished but palpable bilaterally. Ankle-brachial index is 1.3 bilaterally. Serum calcium is 9.8 mg/dL with elevated phosphate. Duplex ultrasound reveals no significant stenosis. Which vascular pathology best explains these findings?
- A)Atherosclerotic intimal plaque with lipid core
- B)Thromboangiitis obliterans with inflammation
- C)Vasculitis from polyarteritis nodosa
- D)Mönckeberg sclerosis with medial calcificationGABARITO
- E)Arterial dissection with intramural hematoma
Explicação
Mönckeberg sclerosis (medial calcific sclerosis) presents with ABI >1.1-1.3 due to rigid calcified vessels that cannot compress. It is characteristic in diabetics with ESRD on dialysis, causing tissue ischemia despite palpable pulses. Ver explicação completa e trilha adaptativa →