UMEM Educational Pearls

Title: What's the Diagnosis? Image by Dr. Connor Lundy

Posted: 3/9/2015 by Haney Mallemat, MD
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35 year-old female presents with acute leg pain and swelling. What's the diagnosis?

Phlegmasia cerulea dolens; there was extensive clot found in the left external iliac, common femoral, superficial femoral, and popliteal veins.

Phlegmasia alba dolens (literally: swollen, white, and painful) is a thrombosis of the major deep veins of the lower extremity. No collateral veins are involved so venous drainage of the leg is reduced but not completely compromised.
Phlegmasia cerulea dolens (literally: swollen, blue, and painful) thrombosis of major deep veins with extension to collateral veins. The result is venous congestions, edema, and can progress to gangrene when arterial flow is compromised.
Anticoagulation with heparin is recommended, although catheter directed thrombolytics or surgical thrombectomy may be recommended when circulation is threatened.

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