Phlegmasia Cerulea Dolens of the Lower Extremities Secondary to Thrombosis of an Inferior Vena Caval Aneurysm

Abstract

We present the clinical case of a 34-year-old male with an aneurysm of the inferior vena cava in which thrombosis led to a picture of bilateral phlegmasia cerulean dolens of the lower extremities. A clear and precise diagnosis was achieved by angio CT which allowed initial conservative management with good immediate and short term outcome. To our knowledge only 23 cases of aneurysm of the inferior vena cava have been reported in the literature worldwide making it difficult to establish a diagnostic and therapeutic algorithm for these cases. Nine cases were presented with thrombosis and in the other 14 the diagnosis was incidental. They mimic a pararenal mass requiring differential diagnosis with retroperitoneal neoplasms.

Trends in Management of Phlegmasia Cerulea Dolens

“…After the initial diagnosis by DUS, additional imaging techniques such as CT or magnetic resonance venography can be performed to provide information on the location and extent of the thrombosis and its possible underlying cause, such as an extrinsic obstructing mass. In this review, some patients underwent CT due to suspected abdominal pathology 9,12,27 and inferior vena cava (IVC) filter thrombosis. 10,11 As an alternative, a more aggressive approach was used, including venography, with the advantage of performing immediate catheter-directed thrombolysis (CDT), 14,17,20,[24][25][26]29,31,34 venous thrombectomy, 8,23,34 IVC filter insertion, 23,34 or a combination of these.…”