Work

Phlegmasia cerulea dolens.

Year: 1967

Type: article

Abstract: A 71-year-old man was admitted to the hospital for severe community-acquired pneumonia. He had a history of chronic obstructive pulmonary disease and atrial fibrillation and was on chronic warfarin therapy. His international normalized ratio (INR) was 9.05. We started the patient on antibiotics and withheld the warfarin. Blood cultures grew Streptococcus pneumoniae. On the 2nd day of hospitalization, the patient's mental status deteriorated. Therefore, after normalization of the INR with fresh frozen plasma and vitamin K, a lumbar puncture was performed to rule out meningitis. Cerebrospinal fluid analysis showed nothing unusual. On day 3, the patient developed shortness of breath and painful swelling of both lower extremities with bluish discoloration of the skin (Fig. 1A). Later, he developed blisters on his feet and dark blue mottled patches on the soles of both feet (Fig. 1B). Multidetector computed tomographic (CT) pulmonary angiography showed a central filling defect in the superior segment of the right lower pulmonary lobe; delayed images of the pelvis and lower extremities without additional contrast material showed bilateral veno-occlusive disease (Fig. 2). The CT examination enabled rapid diagnosis of both pulmonary embolism and deep venous thrombosis at 1 time. Doppler ultrasonography of the lower extremities confirmed extensive deep venous thrombosis. The diagnosis of phlegmasia cerulea dolens was made. Systemic and local tissue-plasminogen activator infusion and AngioJet® thrombectomy (AngioJet® Rheolytic™ Thrombectomy System, Possis Medical, Inc.; Minneapolis, Minn) were used to improve venous outflow. Anticoagulation was resumed, and the patient's condition improved. Fig. 1 A) Swollen and bluish appearance of the legs. B) Patchy distribution of superficial venous gangrene on the soles of both feet. Fig. 2 A) Computed tomographic pulmonary angiography with contrast material shows a pulmonary embolus (arrow), and B) delayed image of the pelvis shows occluded femoral veins bilaterally (arrows).

Source: BMJ

DOI: 10.1136/bmj.1.5542.714

Authors: Salman Sarwar, Srilakshmi Narra, Ahmad Munir

Institutions: University of Tennessee Health Science Center, Memphis VA Medical Center

Language: English

Topic: Venous Thromboembolism Diagnosis and Management

Subfield: Internal Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

OpenAlex ID: W45940644