UMEM Educational Pearls


35 year-old female presents with acute leg pain and swelling. What's the diagnosis?


Phlegmasia cerulea dolens; there was extensive clot found in the left external iliac, common femoral, superficial femoral, and popliteal veins.

  • Phlegmasia alba dolens (literally: swollen, white, and painful) is a thrombosis of the major deep veins of the lower extremity. No collateral veins are involved so venous drainage of the leg is reduced but not completely compromised.
  • Phlegmasia cerulea dolens (literally: swollen, blue, and painful) thrombosis of major deep veins with extension to collateral veins. The result is venous congestions, edema, and can progress to gangrene when arterial flow is compromised.
  • Anticoagulation with heparin is recommended, although catheter directed thrombolytics or surgical thrombectomy may be recommended when circulation is threatened.


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