Check the full list of possible causes and conditions now. In the milder version, phlegmasia alba dolens, collateral venous outflow of the limb remains despite the venous thrombosis. Trends in management of phlegmasia te d cerulea dolens. Phlegmasia cerulea dolens is a rare form of deep venous thrombosis dvt characterized by massive thrombosis of the veins in a lower extremity. Get a printable copy pdf file of the complete article 264k, pdf visual studio 2008 beginners or click on a page. Shackford md, facs, in abernathys surgical secrets seventh edition, 2018. It is the more severe form of phlegmasia alba dolens pad, and can lead to venous gangrene. Phlegmasia alba dolens definition of phlegmasia alba dolens.
This patient presented to the emergency department with the swollen and painful right lower extremity. Diagnosis and treatment of phlegmasia alba dolens and phlegmasia cerulea dolens. Phlegmasia alba dolens article about phlegmasia alba dolens. There is no reason, at an early stage, for doing anything but giving such opiates as are needed and elevating the leg. Phlegmasia alba dolens complicating laparotomy internet archive. Pdf phlegmasia cerulea dolens is a rare form of massive proximal venous thrombosis of the lower extremities associated with a high degree of. Phlegmasia alba dolens definition of phlegmasia alba. We present a unique case of phlegmasia cerulea dolens and compartment syndrome secondary to external iliac vein disruption after revision total hip arthroplasty. Phlegmasia alba and cerulea dolens followup trip database. Phlegmasia cerulea dolens is the more severe form of the two. Dec 08, 2017 the most difficult thing is the decision to act, the rest is merely tenacity.
In phlegmasia alba dolens, the thrombosis involves only major deep venous channels of the extremity, therefore sparing collateral veins. Here are links to possibly useful sources of information about phlegmasia alba dolens. Pad is known by the triad of edema, pain, and blanching alba without cyanosis. To our knowledge, this complication has not yet been described following revision total hip arthroplasty. Diagnosis accurate and prompt diagnosis of dvt is necessary because thrombi left untreated can. Phlegmasia cerulea dolens medical definition merriam. Information and translations of phlegmasia alba dolens in the most comprehensive dictionary definitions resource on the web.
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. Differential diagnosis clinical spectrum of venous thromboembolism. These two entities occur following iliofemoral venous thrombosis, 75% of which occur on the left side presumably because of compression of the left common iliac vein by the overlying right common iliac artery maythurner. With alba you have just severe swelling of the limb without arterial compromise. Phlegmasia cerulea dolens and external iliac vein disruption after. Phlegmasia cerulea dolens phlegmasia cerulea dolens phlegmasia cerulea dolens of the upper extremity advances in the treatment of phlegmasia cerulea dolens. Phlegmasia cerulea dolens and phlegmasia alba dolens can present as compartment syndrome. Pcd, which literally translates to painful blue edema, 3, 5 is part of a spectrum which includes dvt, phlegmasia alba dolens pad, and venous gangrene. Rare case of unilateral phlegmasia cerulea dolens with. It is characterized by sudden severe pain, swelling, cyanosis and edema. It is at this stage that it is called phlegmasia alba dolens. The diagnosis and the efficient treatment are vital to prevent gangrene.
Only 40% of ambulatory ed patients with pe have concomitant dvt. Definition of phlegmasia alba dolens in the dictionary. Phlegmasia cerulea dolens refers to congestion and cyanosis of a limb due to massive venous thrombosis. It has been used in the medical literature in reference to extreme cases of lowerextremity deep venous thrombosis dvt that cause critical limb ischemia and possible limb loss. Phlegmasia alba dolens and the relation of the lymphatics. Phlegmasia cerulea dolens pcd is a rare disease entity involving complete thrombotic occlusion of venous outflow in an extremity, and is considered a vascular emergency. Although this is an entity that is limb and life threatening, with mortality rates as high as 40% and amputation rates as high as 50%, it is rarely encountered by emergency physicians.
An inaugural dissertation, on phlegmasia alba dolens. P hlegmasia cerulea dolens pcd, a lifethreatening complication of deep venous thrombosis dvt, is characterized by massive iliofemoral thrombus that extends to the collateral veins, leading to fluid sequestration and elevated compartment pressures that ultimately compromise arterial flow. It compounds with pulmonary embolism pe and deep vein thrombosis dvt. At this stage it is called phlegmasia cerulea dolens. Phlegmasia cerulea dolens with compartment syndrome. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb. In phlegmasia cerulea dolens, there is complete occlusion of venous out.
Additionally, the edema and loss of venous outflow impedes the arterial inflow. Phlegmasia alba dolens is distinguished, clinically, from phlegmasia cerulea dolens in that there is no ischemia. Syncope and pe probably overstated one international study phlegmasia alba dolens, phlegmasia cerulea dolens and venous gangrene are vascular emergencies. Albino referred to as milk leg or white leg historically seen in pregnant women third trimester or mothers who had just given birth compression of lt iliac vein against the pelvic rim from an enlarged uterus. Phlegmasia alba dolens also colloquially known as milk leg or white leg is part of a spectrum of diseases related to deep vein thrombosis. Pdf phlegmasia cerulea dolens a rare, lifethreatening. Phlegmasia cerulea dolens c at this stage it is called phlegmasia cerulea dolens. Oct 21, 2017 we present a unique case of phlegmasia cerulea dolens and compartment syndrome secondary to external iliac vein disruption after revision total hip arthroplasty. He has a previous stroke but left them with partial pa. Historically, it was commonly seen during pregnancy and in mothers. The code is valid for the year 2020 for the submission of hipaacovered transactions. Phlegmasia alba dolens pad describes the patient with swollen and white leg because of early. The imported definitions may be significantly out of date, and any more recent senses may be completely missing.
Phlegmasia cerulea dolens a rare, lifethreatening condition article pdf available in the scientific world journal 9. Intramuscular pressure in the lower leg in deep vein thrombosis and phlegmasia cerulea. Deep venous thrombosis uncomplicated phlegmasia alba dolens. Phlegmasia cerulea dolens with compartment syndrome youtube. Jan 19, 2018 phlegmasia cerulea dolens is an uncommon, severe form of deep venous thrombosis blood clots in the vein.
Phlegmasia alba and cerulea dolens followup emedicine surgery, 2014. An inaugural dissertation, on phlegmasia alba dolens puerperarum. Phlegmasia cerulea dolens and external iliac vein disruption. Images in clinical medicine from the new england journal of medicine phlegmasia cerulea dolens with compartment syndrome. Phlegmasia cerulea dolens pcd is an uncommon but potentially life threatening. Also known as milk leg explanation of phlegmasia alba dolens. Historically, it was commonly seen during pregnancy and. Historically, it was commonly seen during pregnancy and in mothers who have just given birth. Phlegmasia cerulea dolens a limb threatening problem.
The cause in our patient could have been the rapid reversal of anticoagulation in the setting of decreased mobility and a generalized inflammatory state due to. Treatment options for phlegmasia cerulea dolens pdf free. Plegmasia alba dolens phlegmasia alba dolens alba means white i. Aug, 2018 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. Phlegmasia alba dolens c open in a separate window. We present a unique case of phlegmasia cerulea dolens and compartment syndrome secondary to external. In the milder version, phlegmasia alba dolens, collateral venous out. The phlegmasia cerulla dolens is isquemic venous thrombosis in a reversible state of unknown cause and is a consequence of acute venous obstruction of a venous vascular trunk. Flegmasiia article about a medical condition affecting the circulatory system is a stub. Mumoli n, invernizzi c, luschi r, carmignani g, camaiti a, cei m.
Treatment for phlegmasia completely obstructing dvt is not anticoagulation alone, but rather urgent procedural intervention. Acousticassisted catheterdirected thrombolytic therapy. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Phlegmasia cerulea dolens pcd is an uncommon complication of deep venous thrombosis, which results from extensive thrombotic occlusion of the major and collateral veins of an extremity usually the legs.
We conclude that although vascular complications are fortunately rare after hip arthroplasty, they can have significant. Phlegmasia alba dolens complicating laparotomy by baldy, j. For orthopaedic surgeons, it is important to know that phlegmasia cerulea dolens and phlegmasia alba dolens can present as and lead to compartment syndrome 12. Phlegmasia alba dolens an overview sciencedirect topics. Phlegmasia cerulea dolens can rapidly progress to compartment syndrome and gangrene. Prompt fasciotomies were performed, but the underlying massive venous thrombosis was. Phlegmasia alba dolens cerulra colloquially known as milk leg or white leg is part of a spectrum of diseases related to deep vein thrombosis. Phlegmasia cerulea dolens definition of phlegmasia. Phlegmasia stems from a greek term phlegma meaning inflammation. 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 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. Phlegmasia cerulea dolens postgraduate medical journal. When the entire leg is swollen and discolored, consider the possibility of phlegmasia alba dolens or phlegmasia cerulea dolens ie.
Phlegmasia cerulea dolens definition of phlegmasia cerulea. Phlegmasia alba dolens wikipedia 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. Phlegmasia alba and cerulea dolens clinical presentation. For orthopaedic surgeons, it is important to know that phlegmasia cerulea dolens and phlegmasia alba dolens. Phlegmasia cerulea dolens radiology reference article. Phlegmasia cerulea dolens with compartment syndrome nejm. Phlegmasia cerulea dolens is preceded by a condition called phlegmasia alba dolens. Phlegmasia alba dolens pad describes the patient with swollen and white leg because of early compromise of arterial flow secondary to. Phlegmasia cerulea dolens request pdf researchgate. Aug, 2018 mumoli n, invernizzi c, luschi r, carmignani g, camaiti a, cei m. Between phlegmasia alba dolens and phlegmasia cerulea dolens. In the lower extremities, leftside involvement is three to four times more common. 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. These images are a random sampling from a bing search on the term phlegmasia.
This occurs when the leg is swollen and white due to a clot in a deep vein that blocks blood flow. The pathologic physiology of phlegmasia cerulea dolens. Phlegmasia coerulea dolensphlegmasia cerulea dolens. Most cases described encompass the lower extremities. Pain, edema, and discoloration is described as phlegmasia alba dolens painful white inflammation 29. A painful swelling of the leg usually seen postpartum, due to femoral vein thrombophlebitis or lymphatic obstruction. Fulminant phlegmasia cerulea dolens with concurrent cholangiocarcinoma and a lupus anticoagulant. Flegmasia cerulea dolens pdf phlegmasia cerulea dolens literally.
Request pdf on jan 23, 2012, bernhard petritsch and others published phlegmasia cerulea dolens of the arm find, read and cite all the research you need on researchgate. All may occur at any age, but are more common during the fifth and sixth decades of life. Phlegmasia cerulea dolens with compartment syndrome ncbi. Phlegmasia cerulea dolens is an uncommon severe form of deep venous thrombosis which results from extensive thrombotic occlusion of the major and the collateral veins of an extremity. Presumptive diagnosis is made on clinical grounds and confirmed with a pointofcare ultrasound pocus. 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. 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. In cases of pregnancy, it is most often seen during the third trimester, resulting from a compression of the left common iliac vein against the pelvic rim by the. All three manifestations result from acute massive venous thrombosis and obstruction of the venous drainage of an extremity. Phlegmasia dolens is a rare form of massive venous thrombosis of the lower extremities that is associated with a high degree of morbidity, including venous gangrene, compartment type syndrome, and arterial compromise. There is a high risk of massive pulmonary embolism, even under anticoagulation. Pronunciation of phlegmasia cerulea dolens with 1 audio pronunciation, 1 meaning, 2 translations and more for phlegmasia cerulea dolens.
434 1230 1041 898 778 1238 613 283 174 1511 372 180 461 1274 190 262 818 1483 9 34 710 1117 889 1077 1382 867 126 246 1540 176 80 1 459 216 522 684 539 1350 75 1399 1132 81 595