Phlegmasia cerulea dolens: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Ortho" to "Category:Orthopedics") |
Neil.m.young (talk | contribs) (Text replacement - "* " to "*") |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
* "Painful Blue Leg" | *"Painful Blue Leg" | ||
* Massive iliofemoral occlusion | *Massive iliofemoral occlusion | ||
* Extensive vascular congestion and venous ischemia | *Extensive vascular congestion and venous ischemia | ||
===Risk Factors=== | ===Risk Factors=== | ||
* Age 50-60s | *Age 50-60s | ||
* Malignancy (20-40%) | *Malignancy (20-40%) | ||
* Idiopathic (10%) | *Idiopathic (10%) | ||
* Inherited thrombophilia | *Inherited thrombophilia | ||
* Pregnancy | *Pregnancy | ||
* Trauma/surgery | *Trauma/surgery | ||
* IVC filter | *IVC filter | ||
==Clinical Features== | ==Clinical Features== | ||
* Sudden severe leg pain | *Sudden severe leg pain | ||
* Swelling and edema (bleb/bullae) | *Swelling and edema (bleb/bullae) | ||
* Cyanosis | *Cyanosis | ||
* Venous gangrene | *Venous gangrene | ||
* [[Compartment syndrome]] | *[[Compartment syndrome]] | ||
* Arterial compromise | *Arterial compromise | ||
* Shock | *Shock | ||
* Often preceded by [[phlegmasia alba dolens]] | *Often preceded by [[phlegmasia alba dolens]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Venous thromboembolism types}} | {{Venous thromboembolism types}} | ||
* [[Cellulitis]] | *[[Cellulitis]] | ||
* [[Lymphedema]] | *[[Lymphedema]] | ||
* [[Venous valvular insufficiency]] | *[[Venous valvular insufficiency]] | ||
* [[Superficial thrombophlebitis]] | *[[Superficial thrombophlebitis]] | ||
==Diagnosis== | ==Diagnosis== | ||
* Clinical diagnosis | *Clinical diagnosis | ||
* Duplex US | *Duplex US | ||
* Contrast venography | *Contrast venography | ||
==Management== | ==Management== | ||
* For mild, non-gangrenous form: Conservative management | *For mild, non-gangrenous form: Conservative management | ||
** Steep limb elevation | **Steep limb elevation | ||
** Fluid resuscitation | **Fluid resuscitation | ||
** Heparin: 80-100U/kg followed by infusion of 15-18U/kg/hr | **Heparin: 80-100U/kg followed by infusion of 15-18U/kg/hr | ||
* Vascular surgery consult for emergent thrombectomy | *Vascular surgery consult for emergent thrombectomy | ||
* Interventional radiology consult for emergent catheter-directed thrombolysis | *Interventional radiology consult for emergent catheter-directed thrombolysis | ||
* Thrombolytic therapy | *Thrombolytic therapy | ||
**Alteplase (1mg/min to total of 50mg) distal to thrombus | **Alteplase (1mg/min to total of 50mg) distal to thrombus | ||
Revision as of 20:02, 4 July 2016
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
- 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]
Diagnosis
- 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.