Phlegmasia cerulea dolens: Difference between revisions
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* Contrast venography | * Contrast venography | ||
==Management== | ==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 | * 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 | ||
==Disposition== | ==Disposition== | ||
Revision as of 20:11, 22 December 2014
Background
- "Painful Blue Leg"
- Massive iliofemoral occlusion
- Extensive vascular congestion and venous ischemia
Clinical Spectrum of Venous Thromboembolism
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]
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
- Phlegmasia alba dolens
- DVT
- Cellulitis
- Lymphedema
- Venous valvular insufficiency
- Superficial thrombophlebitis
Workup
- 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
Sources
- ↑ 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.