In the lower extremities, leftside involvement is three to four times more common. Phlegmasia cerulea dolens refers to congestion and cyanosis of a limb due to massive venous thrombosis. This form of phlebitis is known by a number of names, most of which are descriptive of its clinical findings. It compounds with pulmonary embolism pe and deep vein thrombosis dvt. An 85yearold woman with newly diagnosed metastatic nonsmallcell lung cancer was admitted for pain control. Phlegmasia alba dolens pad and phlegmasia cerulea dolens pcd predominantly affect the lower extremities, with fewer than 5% of cases believed to involve the upper extremities. Patients usually present with edema, pain, blanching and it may progress to gangrene and systemic shock in severe cases. Phlegmasia cerulea dolens blue, painful leg is an uncommon manifestation of deepvein thrombosis and results from massive thrombosis compromising venous outflow, which causes ischemia. Phlegmasia cerulea dolens differs from phlegmasia alba dolens in that the onset is more sudden and the symptoms more severe.
Phlegmasia cerulean dolens is a severe form of deep venous thrombosis characterized by severe venous outflow obstruction, marked limb swelling, pain, bluish. Phlegmasia cerulean dolens is a severe form of deep venous thrombosis characterized by severe venous outflow obstruction, marked limb swelling, pain, bluish discoloration, and even venous gangrene if the condition is untreated. It was first described by hildanus in the 16 th century. Caso clinico flegmasia cerulea dolens, tratamiento endovascular. Phlegmasia cerulea dolens with compartment syndrome ncbi.
A 72yearold woman with recently diagnosed squamous cell cancer of the neck presented with a 3day history of left leg pain and swelling. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Phlegmasia cerulea dolens pcd is a severe presentation of massive dvt, and it is often associated with extremity catheterdirected thrombolytic therapy in deep venous thrombosis of the lower extremity. Ischemic forms of acute venous thrombosis jama dermatology. Flegmasia cerulea dolens phlegmasia cerulla dolens dra. Pcd is defined as phlegmasia cerulea dolens frequently. Phlegmasia cerulea dolens describes clot formation in the venous system over a large area. Phlegmasia cerulea dolens symptoms, treatments and. Blisters that are getting larger and occasionally leak blood tinged serous fluid. Pdf phlegmasia cerulea dolens from radiationinduced. Deep vein thrombosis dvt is a condition that occurs when a blood clot forms in a vein deep inside a. Historically, it commonly was seen pathophysiology. Lewis 1891 an elementary latin dictionary, new york. Cyanosis is pathognomic for phlegmasia cerulea dolens.
Pdf phlegmasia cerulea dolens a rare, lifethreatening. Diagnosis of pulmonary embolism by multidetector ct alone or combined with venous ultrasonography of the leg. Phlegmasia cerulea dolens in a patient treated with. Pcd is the term used to describe lowerextremity dvt that causes limb ischemia, and is characterized by severe swelling and blue discoloration of the extremity. Phlegmasia cerulea dolens is one of the infrequent but most severe forms of venous thrombotic disease. Phlegmasia cerulea dolens pcd represents the most severe acute consequence of dvt. Phlegmasia cerulea dolens pcd is an uncommon but potentially lifethreatening complication of acute dvt characterized by marked swelling of the extremities with pain and cyanosis, which in turn may lead to arterial ischemia and ultimately cause gangrene with high amputation and mortality rates. Phlegmasia cerulea dolens is preceded by a condition called phlegmasia alba dolens.
We present a rare case of bilateral pcd in the lower extremities. Only 40% of ambulatory ed patients with pe have concomitant dvt. Lewis and charles short 1879 a latin dictionary, oxford. Phlegmasia cerulea dolens with compartment syndrome. Phlegmasia cerulea dolens, inferior vena cava filter, pulmonary embolism. Phlegmasia cerulea dolens is an uncommon, severe form of deep venous thrombosis blood clots in the vein, usually in the upper leg. Retrieved january 16, this article has been cited fleg,asia other articles in pmc. Phlegmasia cerulea dolens phlegmasia erulea dolens pd erulea means lue referred to as painful lue leg rare condition that occurs in a rare, lifethreatening condition article pdf available in the scientific world journal 9.
Pdf on dec 1, 2016, suman paul and others published phlegmasia cerulea dolens from radiationinduced venous stenosis find, read and cite all the research you need on researchgate. In phlegmasia alba dolens, the thrombosis involves only major deep venous channels of the extremity, therefore sparing collateral veins. Prompt diagnosis along with pharmacological and endovascular therapy is the key to avoiding complications such as gangrene 4060 %, amputation 2050 %, and death 2540 %. Phlegmasia cerulea dolens definition of phlegmasia. It is the more severe form of phlegmasia alba dolens pad, and can lead to venous gangrene. It is therefore logical to deliver the lytic agent to the capillary bed by the arterial route. Phlegmasia cerulea dolens is a rare but severe form of deep venous thrombosis which results from extensive thrombotic occlusion of the major extremity veins and their collaterals pathogenesis. Phlegmasia cerulea dolens is an unusual and severe complication of deep.
There are 2 terms under the parent term phlegmasia alba dolens in the icd10cm alphabetical index. The distinguishing features are a violaceous discoloration of the skin of the affected extremity, accompanied with diminished or absent arterial pulsations and with temperature and sensory alterations. Phlegmasia cerulea dolens and venous gangrene, in haimovicis vascular surgery, 6th. Phlegmasia cerulea dolens pcd is more advanced and considered a precursor of frank venous gangrene. Phlegmasia cerulea dolens pcd is a rare form of massive venous thrombosis of the lower extremities associated. Phlegmasia cerulea dolens is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb. Phlegmasia cerulea dolens with compartment syndrome youtube. Phlegmasia cerulea dolens a limb threatening problem. Phlegmasia cerulea dolens pcd is an uncommon but potentially lifethreatening. Phlegmasia cerulea dolens phlebitis blue of gregoire. Phlegmasia cerulea dolens medical definition merriam. Phlegmasia alba and cerulea dolens clinical presentation. Phlegmasia alba dolens is part of a spectrum of diseases related to deep vein thrombosis. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb.
Phlegmasia cerulea dolens pcd is a rare form of massive venous thrombosis of the lower extremities associated with a high degree of morbidity including venous gangrene, compartment syndrome, and arterial compromise. Pad is known by the triad of edema, pain, and blanching alba without cyanosis. There is a high risk of massive pulmonary embolism. Phlegmasia cerulea dolens pcd is an uncommon but potentially life threatening. The icd10cm alphabetical index is designed to allow medical coders to look up various medical terms and connect them with the appropriate icd codes.
Phlegmasia cerulea dolens c he had a history of chronic obstructive pulmonary disease and atrial fibrillation and was on chronic warfarin therapy. This occurs when the leg is swollen and white due to a clot in a deep vein that blocks blood flow. A case of phlegmasia cerulea dolens as a complication caused. Phlegmasia cerulea dolens is an uncommon, severe form of deep venous thrombosis blood clots in the vein. In phlegmasia cerulea dolens the primary lesion is the thrombosis within the capillary bed leading to compartment syndrome and subsequent gangrene. A 67yearold woman presented with newly diagnosed squamous cell cancer of unknown primary origin with lymph node metastases to the neck. Despite all of the therapeutic modalities described above, phlegmasia cerulea dolens and venous gangrene still remain lifethreatening and. Phlegmasia cerulea dolens with compartment syndrome via the new england journal of medicine. Symptoms severe pain, rapid swelling, and bluishskin coloring affect the area below the blocked vein. It is characterized by sudden severe pain, swelling, cyanosis and edema. Phlegmasia cerulea dolens definition at, a free online dictionary with pronunciation, synonyms and translation. Phlegmasia cerulea dolens is a rare disease that presents with acute complete. Phlegmasia cerulea dolens pcd is a rare, fulminant, potentially lethal and often debilitating presentation of deep venous thrombosis dvt.
Bambury lecture on venous and lymphatic disorders of. Phlegmasia alba dolens definition of phlegmasia alba. Phlegmasia alba dolens pad describes the patient with swollen and white leg because of early compromise of arterial flow secondary to. A case of phlegmasia cerulea dolens somasamudra p broomfield hospital, chelmsford, united kingdom. Clinically there is sudden severe pain in a part of an extremity which quickly spreads to involve the whole limb. Phlegmasia cerulea dolens is a rare syndrome caused by diffuse venous thrombosis that is characterized by sudden pain, swelling, purple ecchymosis, and arterial ischemia with loss of distal pulses. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. The code is valid for the year 2020 for the submission of hipaacovered transactions. Phlegmasia cerulea dolens in patient with systemic lupus.