Splinter hemorrhage

For patient information, click Splinter hemorrhage

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

Synonyms and keywords: Splinter haemorrhages

Splinter hemorrhages are small areas of bleeding (hemorrhage) under the fingernails or toenails. Splinter hemorrhages look like thin, red to reddish-brown lines of blood under the nails. They run in the direction of nail growth.

They are named splinter hemorrhages because they look like a splinter under the fingernail.

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.

Splinter hemorrhage is a nonspecific finding and can be associated with^[1][2]:

• Antiphospholipid syndrome
• Janeway spots
• Psoriatic nails
• Rheumatoid arthritis
• Scleroderma
• Subacute bacterial endocarditis
• Systemic lupus erythematosus (SLE)
• Trauma
• Trichinosis

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

Initially splinter hemorrhages are plum-colored, but they then darken to a brown or black color in several days.

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.

Physical examination may include special attention to the heart and blood circulation systems.

Laboratory studies may include:

• Blood cultures
• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR)