Atheroembolic signals detected by Doppler ultrasound scan monitoring in a patient with blue toe syndrome: report of a case.

It is generally accepted that clinical symptoms give the only clue to the presence of atheroemboli in patients with blue toe syndrome (BTS). We report a case of atheroemboli originating from the abdominal aortic aneurysm in which Doppler ultrasound successfully detected atheroembolic signals, which vanished immediately after surgery. To our knowledge, this is the first such case to be documented. When a 67-year-old man was given warfarin after aortocoronay bypass, digital cyanosis suddenly developed, which became worse and was very painful. Angiography and computed tomography scanning revealed an infrarenal aortic aneurysm with mural thrombus. Doppler ultrasound detected atheroemboli as high-intensity transient signals in the bilateral tibioperoneal trunks. After aneurysmectomy and a bifurcated graft replacement, the cyanotic and painful toes improved immediately. Microscopically, cholesterin crystals were seen in the arterioles of the amputated digits. Thus, Doppler ultrasound could be a valuable test to determine the appropriate treatment for patients at risk of atheroembolic BTS.