Intermittent digital cyanosis as the sole presenting sign of pulmonary embolus: an unusual case report

A 77-year-old man who was undergoing comprehensive rehabilitation for a right subcapital femoral neck fracture presented with intermittent digital cyanosis of 3 days duration. He had no other cardiopulmonary signs or symptoms, therefore a diagnosis of Raynaud's Phenomenon was considered but ruled out because of no prior history of similar episodes or associated conditions. A ventilation-perfusion (V/Q) scan was obtained and was highly indicative of pulmonary embolus. Dopplers and impedance plethysmography (IPG) revealed a left lower extremity deep vein thrombosis. Heparinization resulted in cessation of the cyanotic episodes. Intermittent digital cyanosis as the sole presentation of pulmonary embolus has not been previously reported in humans. Pulmonary embolus is notoriously difficult to diagnose based on clinical signs and symptoms. Intermittent peripheral cyanosis should raise the index of suspicion for the possibility of pulmonary embolus.