Phlegmasia Cerulea Dolens, a Deadly Complication of Deep Vein Thrombosis: Case Report and Review of Literature

Abstract

Phlegmasia cerulea dolens (PCD) is a rare limb and life-threatening condition caused by extensive deep vein thrombosis of the extremities, and it is classically associated with extensive oedema, severe pain, and skin mottling, which may lead to compartment syndrome, venous gangrene, and even death.A 40-year-old male, with a background history of right femoral vein thrombosis, cardiomyopathy, with an ejection fraction of only 10%, presented with three days history of progressive swelling, pain, and discolouration of the right lower limb. He was treated with therapeutic low molecular weight heparin along with supportive care with intravenous fluids and pain relief. In view of his poor ejection fraction, he was treated non-operatively with supportive care. The patient succumbed after three months of presentation. PCD is a rare vascular emergency condition that if not recognized early and treated aggressively may lead to higher morbidity and mortality.

A blistering variant of phlegmasia cerulea dolens from underlying squamous cell lung cancer

“…Phlegmasia cerulea dolens is an uncommon condition whereby a massive DVT causes venous drainage obstruction, most often among patients aged 40-50 years. 1 Risk factors include malignant disease, femoral vein catheterization, heparininduced thrombocytopenia, antiphospholipid syndrome and pregnancy. 1,2 The classic symptom triad includes edema, intractable pain from increased compartment pressure and progressive cyanosis owing to venous engorgement with deoxygenated blood.…”

“…1 Risk factors include malignant disease, femoral vein catheterization, heparininduced thrombocytopenia, antiphospholipid syndrome and pregnancy. 1,2 The classic symptom triad includes edema, intractable pain from increased compartment pressure and progressive cyanosis owing to venous engorgement with deoxygenated blood. 2 Massive fluid sequestration may cause blisters.…”

“…2,3 Complications include venous gangrene (40%-60% of cases), limb loss (10%-25%) and death (25%-40%). 1,2 Practice | Clinical images…”

Une variante vésiculaire de phlegmasia cerulea dolens liée à un carcinome épidermoïde du poumon sous-jacent

“…La phlegmasia cerulea dolens est un problème de santé peu fréquent où une importante thrombose veineuse profonde cause une obstruction du drainage veineux, le plus souvent chez des patients de 40–50 ans 1 . Les facteurs de risque les plus courants sont un cancer, un cathétérisme de la veine fémorale, une thrombocytopénie induite par l’héparite, un syndrome des antiphospholipides ou une grossesse 1 , 2 .…”

“…La phlegmasia cerulea dolens est un problème de santé peu fréquent où une importante thrombose veineuse profonde cause une obstruction du drainage veineux, le plus souvent chez des patients de 40–50 ans 1 . Les facteurs de risque les plus courants sont un cancer, un cathétérisme de la veine fémorale, une thrombocytopénie induite par l’héparite, un syndrome des antiphospholipides ou une grossesse 1 , 2 . La triade de symptômes classiques comprend un œdème, une douleur irréductible provenant d’une pression accrue des loges et d’une cyanose progressive en raison d’un engorgement veineux par le sang désoxygéné 2 .…”