Question

72 year-old man, one-week post right fem-pop bypass presents with painful blue and black toe. Diagnosis?

Answer

Answer: Blue-Toe Syndrome

• Blue-toe syndrome is acute digital-ischemia, presenting as one or more cold, painful, and cyanotic toes (or other digits).
• Multiple causes:
  • Emboli (most common)
  • Cholesterol emboli from recent endovascular procedure or atherosclerotic plaque rupture
  • Vascular aneurysm
  • Infectious (e.g., endocarditis)
  • Medications (e.g., warfarin)
  • Drugs (e.g., cocaine, methamphetamine, etc.)
• Emergency Department evaluation should focus on determining the underlying cause to prevent limb loss.
• Patients should have emergent vascular consult and admission for potential revascularization.

References

Hirschman, J. et al. Blue (or purple) toe syndrome. J Am Acad Dermatol.2009 Jan;60(1):1-20

O'Keeffe S, et al. Blue toe syndrome: Causes and management.Arch Intern Med. 1992 Nov;152(11):2197-202.

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