Splinter hemorrhage
Hemorrhages in the nail beds usually have a linear distribution near the distal end ,Remember these hemorrhages are not considered to be pathognomonic of infective endocarditis ,they are thought to be caused by dissemination of tiny thrombi do not forget the differniation of splinter hemorrhages from trichiniciasis , splinter hemorrhages are longitudinal whereas in trichiniciasis the hemorrhages are always transverse .
Locally : Look very carefully so as not to miss these lesions , Look at the nails of the fingers of the other hand as well .
Elswhere : Look for other features of infective endocarditis e.g petechial hemorrhages (in conjunctiva or oral mucosa ) , anemia splenomegaly , Osler,s nodes ,Roth spots , Janeway lesions etc.
Common associations :
Trauma especially in manual labourers .
Infective endocarditis .
Septicemia .
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