Phlegmasia cerulea dolens: Difference between revisions
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*Malignancy (20-40%) | *Malignancy (20-40%) | ||
*Inherited thrombophilia | *Inherited thrombophilia | ||
*Pregnancy | *[[Pregnancy]] | ||
*Trauma/surgery | *[[Trauma]]/surgery | ||
*Immobilization | *Immobilization | ||
*IVC filter | *IVC filter | ||
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==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
*Duplex US | *Duplex [[Ultrasound: DVT|US]] | ||
*Contrast venography | *Contrast venography | ||
Revision as of 16:59, 25 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.
- 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.