Phlegmasia cerulea dolens

Background

  • "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]

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

  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 http://emedicine.medscape.com/article/461809-overview.
  • Lip GY, et al. Overview of the treatment of lower extremity deep vein thrombosis (DVT). In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 21, 2014.