Phlegmasia cerulea dolens

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

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
    • Thrombolytic therapy: Alteplase (1mg/min to total of 50mg) distal to thrombus

Disposition

  • Admit

See Also


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.
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