Phlegmasia cerulea dolens: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
No edit summary |
||
| (5 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*"Painful Blue Leg" | *"Painful Blue Leg" | ||
*Massive iliofemoral occlusion | *Massive iliofemoral occlusion due to venous thromboembolism | ||
*Extensive vascular congestion and venous ischemia | *Extensive vascular congestion and venous ischemia | ||
| Line 7: | Line 7: | ||
*Age 50-60s | *Age 50-60s | ||
*Malignancy (20-40%) | *Malignancy (20-40%) | ||
*Inherited thrombophilia | *Inherited thrombophilia | ||
*Pregnancy | *[[Pregnancy]] | ||
*Trauma/surgery | *[[Trauma]]/surgery | ||
*Immobilization | |||
*IVC filter | *IVC filter | ||
*10% of cases are idiopathic and occur in patients without risk factors | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:PCD2016.jpg|thumb|Two hour history of phlegmasia cerulea dolens (left leg)]] | |||
[[File:PMC5198769 vsi-32-201f1.png|thumb|At presentation (A) and post-op day 1 (B).]] | |||
*Sudden severe leg pain | *Sudden severe leg pain | ||
*Swelling and edema (bleb/bullae) | *Swelling and edema (bleb/bullae) | ||
| Line 20: | Line 23: | ||
*[[Compartment syndrome]] | *[[Compartment syndrome]] | ||
*Arterial compromise | *Arterial compromise | ||
*Shock | *[[Shock]] | ||
*Often preceded by [[phlegmasia alba dolens]] | *Often preceded by [[phlegmasia alba dolens]] | ||
| Line 33: | Line 36: | ||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
*Duplex US | *Duplex [[Ultrasound: DVT|US]] | ||
*Contrast venography | *Contrast venography | ||
| Line 43: | Line 46: | ||
*Vascular surgery consult for emergent thrombectomy | *Vascular surgery consult for emergent thrombectomy | ||
*Interventional radiology consult for emergent catheter-directed thrombolysis | *Interventional radiology consult for emergent catheter-directed thrombolysis | ||
*[[Thrombolytic]] therapy | **[[Thrombolytic]] therapy: [[Alteplase]] (1mg/min to total of 50mg) distal to thrombus | ||
==Disposition== | ==Disposition== | ||
| Line 53: | Line 55: | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Vascular]] | [[Category:Vascular]] | ||
Latest revision as of 05:25, 27 September 2019
Background
- "Painful Blue Leg"
- Massive iliofemoral occlusion due to venous thromboembolism
- Extensive vascular congestion and venous ischemia
Risk Factors
- Age 50-60s
- Malignancy (20-40%)
- Inherited thrombophilia
- Pregnancy
- Trauma/surgery
- Immobilization
- IVC filter
- 10% of cases are idiopathic and occur in patients without risk factors
Clinical Features
- Sudden severe leg pain
- Swelling and edema (bleb/bullae)
- Cyanosis
- Venous gangrene
- Compartment syndrome
- Arterial compromise
- Shock
- Often preceded by phlegmasia alba dolens
Differential Diagnosis
Clinical Spectrum of Venous thromboembolism
- Deep venous thrombosis (uncomplicated)
- Phlegmasia alba dolens
- Phlegmasia cerulea dolens
- Venous gangrene
- Pulmonary embolism
- Isolated distal deep venous thrombosis
Only 40% of ambulatory ED patients with PE have concomitant DVT[1][2]
Evaluation
- Clinical diagnosis
- Duplex US
- Contrast venography
Management
- For mild, non-gangrenous form: Conservative management
- Steep limb elevation
- Fluid resuscitation
- Heparin: 80-100U/kg followed by infusion of 15-18U/kg/hr
- Vascular surgery consult for emergent thrombectomy
- Interventional radiology consult for emergent catheter-directed thrombolysis
- Thrombolytic therapy: Alteplase (1mg/min to total of 50mg) distal to thrombus
Disposition
- Admit
See Also
External Links
References
- ↑ Righini M, Le GG, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008; 371(9621):1343-1352.
- ↑ Daniel KR, Jackson RE, Kline JA. Utility of the lower extremity venous ultrasound in the diagnosis and exclusion of pulmonary embolism in outpatients. Ann Emerg Med. 2000; 35(6):547-554.