Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Mar 14;8(2):240-243.
doi: 10.1016/j.jvscit.2022.02.013. eCollection 2022 Jun.

Management of phlegmasia cerulea dolens caused by a giant leiomyoma

Elisabeth Ekkel  1 , Tara Chandran  1 , Michael Trpkovski  2 , Sachinder Hans  1
Affiliations
Case Reports

Management of phlegmasia cerulea dolens caused by a giant leiomyoma

Elisabeth Ekkel et al. J Vasc Surg Cases Innov Tech. .

Abstract

In the present report, we describe the case of a young woman with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent tissue plasminogen activator catheter thrombolysis and mechanical thrombectomy to temporize the condition until she could be evaluated by a gynecologic oncologist to remove the cause of the venous obstruction. Before the hysterectomy, a suprarenal inferior vena cava filter was placed. However, <12 hours after the hysterectomy, she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

Keywords: Phlegmasia cerulea dolens; Thrombectomy; Uterine leiomyoma.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Photograph showing left lower extremity swelling and skin color changes significant for phlegmasia cerulea dolens.
Fig 2
Fig 2
Coronal (Left) and axial (Right) computed tomography (CT) views of an 18.6 × 15.5 × 9.9-cm pelvic mass causing a mass effect on the pelvic structures.
Fig 3
Fig 3
Top Left, Imaging study after tissue plasminogen activator administration and before mechanical thrombectomy. Top Right, Imaging study after mechanical thrombectomy. Bottom, thrombus extracted using the ClotTriever device (Inari Medical, Irvine, CA).
Fig 4
Fig 4
View of the left common iliac vein (CIV) stent.
Fig 5
Fig 5
Photograph showing the left lower extremity at hospital discharge.
See this image and copyright information in PMC

References

    1. Stewart E.A., Laughlin-Tommaso S.K. Uterine leiomyomas (fibroids): epidemiology, clinical features, diagnosis, and natural history. www.uptodate.com/contents/uterine-leiomyomas-fibroids-epidemiology-clini... UpToDate 2021. Available at:
    1. Chaar C.I.O., Satoskar S., Dardik A. Phlegmasia alba and cerulea dolens: background, pathophysiology, epidemiology. https://emedicine.medscape.com/article/461809-overview#showall Medscape 2020. Available at:
    1. Weaver F.A., Meacham P.W., Adkins R.B., Dean R.H. Phlegmasia cerulea dolens: therapeutic considerations. South Med J. 1988;81:306–312. - PubMed
    1. Hari Krishna Reddy M., Sangeetha B., Aruna M., Sarat Chandra V., Venkata Kumar A.C., Ram R., et al. Phlegmasia cerulean dolens: complication of femoral vein catheterization. CEN Case Rep. 2016;5:184–187. - PMC - PubMed
    1. May R., Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8:419–427. - PubMed

Publication types

LinkOut - more resources