Phlegmasia cerulea dolens

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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

Disposition

  • Admit

See Also

External Links

Sources

  • Rosen's
  • UptoDate
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