Phelgmasia Cerulea Dolens Diagnosed by Point-of-Care Ultrasound

Abstract

Phlegmasia cerulea dolens (PCD) is a rare entity that is associated with significant morbidity and mortality, including limb ischemia and pulmonary embolism. Point-of-care ultrasound (POCUS) can expedite the diagnosis, leading to earlier life- and limb-saving treatment. Although primarily used for assessing for the presence of deep venous thrombosis, in the appropriate clinical setting POCUS can also be used to diagnosis PCD as well as to distinguish between venous and arterial occlusion, which can lead to a difference in management. We present a case of phlegmasia cerulea dolens after mild trauma in a patient with an underlying hypercoagulability disorder diagnosed by an emergency physician using POCUS, which expedited treatment with catheter-directed thrombolytic therapy.

Point-of-care ultrasound for diagnosis of Phlegmasia Cerulea Dolens asociated to abdominal aortic aneurysm

“…AAA have been described as a cause of PCD, even as an initial manifestation, due to extrinsic compression of the iliac veins, generating venous stasis and facilitating thrombus formation 4 . POCUS is a tool available to emergency services with evidence that supports its use for the diagnosis of deep vein thrombosis, the finding of non-compressible proximal veins in combination with a mottled, cool, and painful extremity should be sufficient to raise the suspicion of PCD 5 .…”

Phlegmasia Cerulea Dolens: A Life-Threatening Manifestation of Deep Vein Thrombosis

“…This is followed by cyanosis and sensory and/or motor strength of the extremity, with increasing impairment of the arterial circulation resulting in tissue ischemia and gangrene of the affected extremity [ 6 ]. Venous ultrasound remains the first diagnostic modality for DVT [ 6 , 10 ]. Accuracy studies comparing venography and duplex studies have demonstrated that venous ultrasound has a mean sensitivity and specificity of 97% and 94%, respectively, with a mean positive and negative predictive value of 96% and 98% for symptomatic, proximal DVT, respectively [ 11 ].…”

Man with leg pain

“…Non‐traumatic cases of PCD are most commonly associated with malignancy 3 . The preferred imaging modality is Doppler ultrasound and use of point‐of‐care ultrasound by physicians can expedite treatment of PCD 4 . Management includes limb elevation, intravenous fluids, and either systemic anticoagulation, catheter‐directed thrombolysis, thrombectomy, or a combination of these definitive therapies 5 …”

“…3 The preferred imaging modality is Doppler ultrasound and use of point-of-care ultrasound by physicians can expedite treatment of PCD. 4 Management includes…”