Phlegmasia cerulea dolens
|Phlegmasia cerulea dolens|
|A person with a two hour history of phlegmasia cerulea dolens (left leg, right side of image)|
Phlegmasia cerulea dolens (literally: painful blue edema) 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. 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.
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.
Treatment is by catheter directed thrombolytic therapy.
- 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.
- 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.
- Heparin-Induced Thrombocytopenia By Theodore E. Warkentin, Andreas Greinacher, Published 2004, ISBN 0-8247-5625-8
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