Phlegmasia cerulea dolens

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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

Two hour history of phlegmasia cerulea dolens (left leg)
At presentation (A) and post-op day 1 (B).

Differential Diagnosis

Clinical Spectrum of Venous thromboembolism

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

Disposition

  • Admit

See Also

External Links

References

  1. 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.
  2. 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.