Abstract
Phlegmasia cerulea dolens (PCD) can present as leg pain accompanied by bluish discoloration. It is a limb-threatening emergency that needs to be promptly addressed with anticoagulation with consideration of thrombolytics. We present a case of PCD in an 83-year-old female without obvious risk factor for thrombosis, found to have May Thurner Syndrome (MTS) requiring a chemical and mechanical approach to prevent catastrophic outcomes.
Highlights
In individuals presenting with leg pain and discoloration, phlegmasia cerulea dolens (PCD), cyanosis with underlying deep vein thrombosis (DVT), must be ruled out as it is a limb and a life-threatening emergency requiring prompt treatment [1]
We present a case of PCD in a patient with May Thurner Syndrome (MTS) that was promptly diagnosed and treated
Thrombolysis and/or mechanical thrombectomy is reserved for patients with PCD or extensive iliofemoral DVT as can be seen in DVT associated with MTS [7]
Summary
In individuals presenting with leg pain and discoloration, phlegmasia cerulea dolens (PCD), cyanosis with underlying deep vein thrombosis (DVT), must be ruled out as it is a limb and a life-threatening emergency requiring prompt treatment [1]. Being more prevalent in lower extremities and female gender, PCD shares the risk factors for DVT that include pregnancy, recent surgery, and medical conditions predisposing to the formation of thrombus including malignancies and COVID-19 infection [1,2]. An 83-year-old female with a past medical history of hypertension and type 2 diabetes mellitus presented with one day of worsening left leg pain and swelling. Venous duplex ultrasound (VDU) showed extensive LLE DVT with venogram showing severe left common iliac vein stenosis consistent with MTS. She was immediately started on systemic anticoagulation (AC) with un-fractionated heparin. She was bridged to warfarin prior to discharge with a plan for outpatient follow-up
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