- "Painful Blue Leg"
- Massive iliofemoral occlusion due to venous thromboembolism
- Extensive vascular congestion and venous ischemia
- Age 50-60s
- Malignancy (20-40%)
- Inherited thrombophilia
- IVC filter
- 10% of cases are idiopathic and occur in patients without risk factors
Two hour history of phlegmasia cerulea dolens (left leg)
At presentation (A) and post-op day 1 (B).
Only 40% of ambulatory ED patients with PE have concomitant DVT
- 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
- ↑ 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.