Phlegmasia cerulea dolens


  • "Painful Blue Leg"
  • Massive iliofemoral occlusion
  • Extensive vascular congestion and venous ischemia

Risk Factors

  • Age 50-60s
  • Malignancy (20-40%)
  • Idiopathic (10%)
  • Inherited thrombophilia
  • Pregnancy
  • Trauma/surgery
  • IVC filter

Clinical Features

Differential Diagnosis

Clinical Spectrum of Venous thromboembolism

Only 40% of ambulatory ED patients with PE have concomitant DVT[1][2]


  • Clinical diagnosis
  • Duplex US
  • Contrast venography


  • 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


  • Admit

See Also

External Links


  1. 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.
  2. 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.
  • Rosen's Emergency Medicine 8th edition. 2013. Chapter: Pulmonary Embolism and Deep Vein Thrombosis p. 1159.
  • Dardik A. (2014, Feb 25). Phlegmasia Alba and Cerulea Dolens. eMedicine. Retrieved 12/21/2014 from
  • Lip GY, et al. Overview of the treatment of lower extremity deep vein thrombosis (DVT). In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. Accessed December 21, 2014.