Sudden onset blue leg

Cardiovascular Curveball 002

You are managing a 56 year old woman with severe pneumonia in the Intensive Care Unit when you are called to see her because her leg has suddenly turned blue:

Blue leg

Questions

Q1: What is the diagnosis?

Phlegmasia Cerulea Dolens
Less frequent manifestations of venous thrombosis include phlegmasia alba dolens, phlegmasia cerulea dolens, and venous gangrene. These form a clinical spectrum of the same disorder.

All 3 manifestations result from acute massive venous thrombosis and obstruction of the venous drainage of an extremity.  In phlegmasia alba dolens, the thrombosis involves only major deep venous channels of the extremity, therefore sparing collateral veins. The venous drainage is decreased but still present; the lack of venous congestion differentiates this entity from phlegmasia cerulea dolens.

Q2: What are the complications?

Complications of Phlegmasia Cerulea Dolens

  1. Pulmonary embolism
  2. Venous Infarction of the limb
  3. Fluid sequestration in the limb and systemic inflammatory response syndrome leading to hypotension

Q3:  How is this condition managed?

This a rare condition and the management is evolving.

  • Traditional treatment consists of standard anticoagulation
  • However, increasingly, invasive therapies such as catheter directed thrombolysis, surgical thrombectomy and systemic thrombolysis are employed in these patients

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