Blue Toe Differential Diagnosis
The differential diagnosis for blue toe can be organized into the following categories:
- Single most likely diagnosis
- Atherosclerotic peripheral arterial disease: This is the most common cause of blue toe, resulting from atherosclerotic plaque buildup in the peripheral arteries, leading to reduced blood flow to the toes.
- Other Likely diagnoses
- Embolic event: An embolus, often originating from the heart or a proximal artery, can lodge in a peripheral artery, causing sudden onset of blue toe.
- Vasculitis (e.g., Buerger's disease, giant cell arteritis): Inflammation of the blood vessels can lead to reduced blood flow and blue discoloration of the toes.
- Raynaud's phenomenon: A condition characterized by vasospasm of the arteries in response to cold or stress, leading to episodic blue discoloration of the toes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: A life-threatening condition where the inner layer of the aorta tears, potentially leading to reduced blood flow to the lower extremities and blue toe.
- Saddle embolus: A large embolus that lodges at the aortic bifurcation, potentially causing bilateral blue toes and requiring immediate medical attention.
- Rare diagnoses
- Cholesterol crystal embolization: A rare condition where cholesterol crystals break off from an atherosclerotic plaque and embolize to smaller arteries, causing blue toe.
- Cryoglobulinemia: A condition characterized by the presence of abnormal proteins in the blood that can precipitate in cold temperatures, leading to vasculitis and blue toe.
- Antiphospholipid syndrome: An autoimmune disorder that can cause blood clots and vasculitis, potentially leading to blue toe.