Phlegmasia Cerulea Dolens

OVERVIEW

  • Phlegmasia Cerulea Dolens refers to congestion and cyanosis of a limb due to massive venous thrombosis
  • part of a spectrum with phlegmasia alba dolens and venous gangrene

Phlegmasia alba dolens

  • In phlegmasia alba dolens, the thrombosis involves only major deep venous channels of the extremity, therefore sparing collateral veins.
  • The venous drainage is decreased but still present; the lack of venous congestion differentiates this entity from phlegmasia cerulea dolens.

CLINICAL FEATURES

  • sudden onset colour change in leg
  • severe venous congestion
  • venous gangrene (skin, subcutaneous tissue and muscle)
  • shock
  • fluid sequestration
  • arterial insufficiency

INVESTIGATION

  • urgent Doppler ultrasound

MANAGEMENT

Controversial and evolving – options include:

  • anticoagulation
  • thrombectomy
  • catheter-directed thrombolysis or systemic thrombolysis

COMPLICATIONS

  • venous infarction leading to gangrene
  • PE
  • postphlebitic syndrome
  • Fluid sequestration in the affected limb and SIRS leading to hypotension and shock
  • arterial insufficiency due to congestion

References and Links

LITFL


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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