A 72-year-old man presented with unstable angina. An urgent cardiac catheterization showed clinically significant disease in the right coronary artery, which was stented. Twelve hours after the procedure, livedo reticularis developed on his legs and there was a bluish discoloration of his toes.

做完心導管後12小時,腳上出現像網狀一樣的青斑..這就是livedo reticularis.

Livedo reticularis是一種網狀的紅到藍斑..在cold exposure下會更明顯..

DDx of livedo reticularis

1. Idiopathic livedo reticularis
2. Secondary livedo reticularis:
- Livedoid vasculitis
- Polyarteritis nodosa
- Systemic lupus erythematosus
- Dermatomyositis
- Rheumatoid arthritis
- Lymphoma
- Pancreatitis
- Tuberculosis
- Amantadine
- Cryoglobulinaemia
- Antiphospholipid syndrome due to small blood clots
- Hypercalcaemia
- Haematological disorders of Polycythaemia rubra vera or Thrombocytosis
- Infections (syphilis and tuberculosis)
- Cholesterol emboli and homocystinuria

Wiki of livedo reticularis

接下來..

The evaluation was notable for an increase in his serum creatinine level from 1.5 mg/dl to 3.1 mg/dl, eosinophilia of 7.4 percent, and a normal result on renal ultrasonography.

看起來腎臟功能很短的時間內惡化..也就是急性腎衰竭..腎臟超音波並未發現hydronephrosis或是post-renal causes of acute renal failure..

答案是"cholesterol emboli"

Adapted from N Engl J Med. 2006; 354: 1294