Phlegmasia cerulea dolens: Difference between revisions
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==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 | ||
=== | ===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== | ==Clinical Features== | ||
* Sudden severe leg pain | [[File:PCD2016.jpg|thumb|Two hour history of phlegmasia cerulea dolens (left leg)]] | ||
* Swelling and edema (bleb/bullae) | [[File:PMC5198769 vsi-32-201f1.png|thumb|At presentation (A) and post-op day 1 (B).]] | ||
* Cyanosis | *Sudden severe leg pain | ||
* Venous gangrene | *Swelling and edema (bleb/bullae) | ||
* [[Compartment syndrome]] | *Cyanosis | ||
* Arterial compromise | *Venous gangrene | ||
* Shock | *[[Compartment syndrome]] | ||
* Often preceded by [[phlegmasia alba dolens]] | *Arterial compromise | ||
*[[Shock]] | |||
*Often preceded by [[phlegmasia alba dolens]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Venous thromboembolism types}} | |||
* Cellulitis | *[[Cellulitis]] | ||
* Lymphedema | *[[Lymphedema]] | ||
* Venous valvular insufficiency | *[[Venous valvular insufficiency]] | ||
* Superficial thrombophlebitis | *[[Superficial thrombophlebitis]] | ||
== | |||
* Clinical diagnosis | ==Evaluation== | ||
* Duplex US | *Clinical diagnosis | ||
* Contrast venography | *Duplex [[Ultrasound: DVT|US]] | ||
*Contrast venography | |||
==Management== | ==Management== | ||
* Vascular surgery consult for emergent thrombectomy | *For mild, non-gangrenous form: Conservative management | ||
* Interventional radiology consult for emergent catheter-directed thrombolysis | **Steep limb elevation | ||
* Thrombolytic therapy | **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== | ==Disposition== | ||
*Admit | *Admit | ||
==See Also== | ==See Also== | ||
*[[Venous thromboembolism]] | *[[Venous thromboembolism]] | ||
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==External Links== | ==External Links== | ||
== | |||
==References== | |||
<references/> | <references/> | ||
[[Category:Cardiology]] | |||
[[Category:Orthopedics]] | |||
[[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.