title: Heterotopic ossification of small saphenous vein and panniculitis ossificans of chronic venous insufficiency presenting with livedo racemosa.
abstract: OBJECTIVE
  Livedo racemosa is a reticulate eruption that presents with branched and partially blanchable incomplete rings. Livedo racemosa is distinct from livedo reticularis, a similar condition that presents with a diffuse and symmetrical blanchable eruption. In contrast to livedo reticularis which may be physiological, livedo racemosa is always associated with an underlying pathology. To our knowledge, this is the first report of panniculitis ossificans and heterotopic ossification of small saphenous vein (SSV) presenting with livedo racemosa.
  
  
  METHODS
  We present a 70-year-old male referred for investigation and management of progressive pigmentation and 'lipodermatosclerosis' of lower limbs. There was no history of deep venous thrombosis but an earlier ultrasound had detected a non-occlusive thrombus in the left SSV. Examination and investigations revealed the skin eruption to be livedo racemosa and the associated subcutaneous induration and nodularity to be due to panniculitis ossificans. Biopsy of the SSV demonstrated segmental heterotopic ossification. Duplex ultrasound demonstrated bilateral superficial and deep venous incompetence but no evidence of an acute or chronic venous thrombosis. The patient was diagnosed with heterotopic ossification secondary to venous insufficiency and managed conservatively.
  
  
  CONCLUSIONS
  Livedo racemosa may be an early sign of panniculitis ossificans and its presence should trigger further diagnostic investigations.
authors.affiliation: Venus Centre Vein Clinic, Brisbane, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Lekich
authors.affiliation: Department of Dermatology, St. Vincent's Hospital, Sydney, Australia University of New South Wales, Sydney, Australia kparsi@stvincents.com.au.
authors.forename: Kurosh
authors.initials: K
authors.lastname: Parsi
mesh_terms: D000368:Aged; D006801:Humans; D054068:Livedo Reticularis / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D009999:Ossification, Heterotopic / Q000150:complications / Q000000981:diagnostic imaging; D015434:Panniculitis / Q000150:complications / Q000000981:diagnostic imaging; D012501:Saphenous Vein / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging
keywords: Livedo racemosa; chronic venous insufficiency; heterotopic ossification; panniculitis ossificans; small saphenous vein