UMEM Educational Pearls

Title: What's the diagnosis? Pearl submitted and written by Dr. Zachary Dezman

Category: Visual Diagnosis

Posted: 10/30/2011 by Haney Mallemat, MD (Updated: 10/31/2011)
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72 year-old man, one-week post right fem-pop bypass presents with painful blue and black toe. Diagnosis?

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.

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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