Phlegmasia cerulea dolens
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 (L>R)
- 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
- 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
- Heparin therapy after thrombolytics
- 80-100U/kg followed by infusion of 15-18U/kg/hr
Disposition
- Admit
See Also
External Links
Sources
- 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.