A Deadly Cerulean Limb- Phlegmasia Cerulea Dolens Complicated with Pulmonary Embolism

Aims: Asses the presentation of phlegmasia cerulea dolens and differentiate venous etiologies of ischemic limb with arterial thrombus

Background: Phlegmasia cerulea dolen (PCD) is a rare condition that is responsible for mortality up 20-40%, mainly due to pulmonary embolism. Medical therapy involves administration of anticoagulants such as IV Heparin during acute setting should be initiated as soon as possible, followed by oral factor 10a inhibitors ie; rivaroxaban up to 6 months. Surgical therapy such as catheter-directed thrombolytics however remain a mainstay

Case Description: A case reported in a 51 years-old woman with underlying metastatic endometrial carcinoma, presented with sudden onset of pain and swelling of left leg. Initial bedside doppler show patent arterial perfusion over the affected leg. It was later developed into bluish discolouration and bedside doppler show poor perfusion of arteries. Subsequently, she succumbed to illness less than 24 hours from first presentation due to suspected pulmonary embolism.

Discussion and Conclusion: Patients with increased risk of developing deep vein thrombosis (DVT) such as those with underlying malignancy have shown to develop a more extreme case of the disease. Phlegmasia cerulea dolens (PCD) is a rare manifestation of DVT over lower extremities that cause critical limb ischemia. Incidence of PCD is unknown however, it is estimated from a case series about 10-20% of patients underwent thrombolysis for extensive DVT, developed into phlegmasia. Common risk factors that contribute to developing PCD are malignancy, surgery and trauma.