Phlegmasia cerulea dolens

Phlegmasia cerulea dolens (literally: painful blue inflammation) is an uncommon severe form of deep venous thrombosis which results from extensive thrombotic occlusion (blockage by a thrombus) of the major and the collateral veins of an extremity.[1][2] It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb. There is a high risk of massive pulmonary embolism, even under anticoagulation. Foot gangrene may also occur. An underlying malignancy is found in 50% of cases. Usually, it occurs in those afflicted by a life-threatening illness.[1]

Phlegmasia cerulea dolens
A person with a two hour history of phlegmasia cerulea dolens (left leg, right side of image)

This phenomenon was discovered by Jonathan Towne, a vascular surgeon in Milwaukee, who was also the first to report the "white clot syndrome" (now called heparin induced thrombocytopenia [HIT]). Two of their HIT patients developed phlegmasia cerulea dolens that went on to become gangrenous.[3]

Treatment is by catheter-directed thrombolytic therapy, a type of thrombolysis.[4]

Additional images
Deep vein thrombosis of the left external iliac in a person with bladder cancer resulting in this condition.
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See also

References
  1. John T. Owings (December 2005). "Management of Venous Thromboembolism". ACS Surgery. American College of Surgeons. Archived from the original on January 27, 2012. Retrieved January 16, 2012.
  2. Barham, Kalleen; Tina Shah (2007-01-18). "Images in Clinical Medicine: Phlegmasia Cerulea Dolens". The New England Journal of Medicine. 356 (3): e3. doi:10.1056/NEJMicm054730. PMID 17229945.
  3. Heparin-Induced Thrombocytopenia By Theodore E. Warkentin, Andreas Greinacher, Published 2004, ISBN 0-8247-5625-8
  4. Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan C, Chunilal SD, Ward CM, Baker R, Nandurkar H (March 2019). "New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism". The Medical Journal of Australia. 210 (5): 227–235. doi:10.5694/mja2.50004. PMID 30739331.
Classification
External resources


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