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Telangiectasias in a row

Published:February 02, 2022DOI:https://doi.org/10.1016/j.ejim.2022.01.039

      1. Case description

      A 29-year-old man presented with an 11-year history of asymptomatic venous telangiectasias forming a sinuous line along the anterolateral part of the thorax at the level of the lower ribs and xiphoid process (Fig. 1). He also stated that his 22-year-old brother had the same condition. Physical examination revealed no other abnormalities. Abdominal ultrasound and complete blood tests including liver profile, full blood count and coagulation indexes were all normal; screening tests for HIV and hepatitis B and C virus were also negative. What is your diagnosis?
      Fig 1
      Fig. 1(A, B) Dilated small veins forming a sinuous transverse line along the lower anterior part of the thorax. (C) Detailed view of telangiectasias.

      2. Diagnosis and discussion

      The clinical diagnosis of costal fringe was finally made.
      Costal fringe is an easily recognizable condition consisting of a band of telangiectasias in the inferior part of the anterior thorax, which seems not to be strictly related to underlying structures, such as ribs or diaphragm [
      • Bean W.B.
      Vascular spiders and related lesions of the skin.
      ,
      • Sartori C.R.
      • Baker E.J.
      • Hobbs E.R.
      Costal fringe.
      ]. Nevertheless, it may often be overlooked by physicians, which might explain why so little has been published about this clinical finding. Although the exact prevalence of costal fringe remains unknown, it has traditionally been described more commonly in the elderly (probably due to age-related skin thinning and small vessel dilation), being a rare condition among young people [
      • Sartori C.R.
      • Baker E.J.
      • Hobbs E.R.
      Costal fringe.
      ].
      Costal fringe is considered an incidental finding without clinical significance, since it has not been consistently linked to pathological conditions [
      • Bean W.B.
      Vascular spiders and related lesions of the skin.
      ,
      • Sartori C.R.
      • Baker E.J.
      • Hobbs E.R.
      Costal fringe.
      ]. However, it should be distinguished from other forms of localized telangiectasias that may be associated with underlying illnesses, such as vascular spiders in liver disease [
      • Gupta R.
      • Gautam R.K.
      • Bhardwaj M.
      • Chauhan A.
      A clinical approach to diagnose patients with localized telangiectasia.
      ]. Thus, physicians ought to become familiar with the typical shape and location of costal fringe in order to make an accurate clinical diagnosis of this cutaneous manifestation, avoiding therefore unnecessary complementary tests.

      Declaration of Competing Interest

      Authors do not have any conflict of interest to disclose.

      References

        • Bean W.B.
        Vascular spiders and related lesions of the skin.
        Springfield, Illinois: Charles C Thomas, 1958: 227-268 (Chapter VII, Vascular lesions which increase with aging)
        • Sartori C.R.
        • Baker E.J.
        • Hobbs E.R.
        Costal fringe.
        Arch Dermatol. 1991; 127: 1201-1202
        • Gupta R.
        • Gautam R.K.
        • Bhardwaj M.
        • Chauhan A.
        A clinical approach to diagnose patients with localized telangiectasia.
        Int J Dermatol. 2015; 54: e294-e301