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
. 2025 Jan 19;17(1):e77678.
doi: 10.7759/cureus.77678. eCollection 2025 Jan.

Phlegmasia Cerulea Dolens: A Rare Vascular Emergency

Lucas N Canaan  1 , Daniel Whitson  1 , Deepak Dev Vivekanandan  1 , Nizar Hariri  2
Affiliations
Case Reports

Phlegmasia Cerulea Dolens: A Rare Vascular Emergency

Lucas N Canaan et al. Cureus. .

Abstract

Phlegmasia cerulea dolens (PCD) is a rare condition characterized by near-complete to total occlusion of an extremity, leading to discoloration, cyanosis, and pain caused by venous thromboembolism (VTE). The inciting events leading to VTE formation can vary widely and may include factors such as trauma or malignancy. In many cases, the underlying thrombus can be managed with anticoagulation. However, surgical intervention is required in certain situations, such as this patient. Prompt action is essential regardless of the treatment modality, as the underlying disease process can significantly threaten the affected limb. This pathology is associated with a high rate of amputation and mortality. This case report discusses a 69-year-old female with a thrombus affecting the common iliac, external iliac, femoral, popliteal, and tibial veins, resulting in PCD. It emphasizes the importance of urgent intervention and treatment and the severe consequences of this disease process.

Keywords: amputation; deep vein thrombosis (dvt); heparin-induced thrombocytopenia (hit); phlegmasia cerulea dolens; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Swelling and discoloration of the patient’s left leg on admission to the hospital prior to surgical intervention
Figure 2
Figure 2. Duplex of the left common femoral vein demonstrating non-compressible thrombus and no flow within the area of the white box
Figure 3
Figure 3. Initial venogram showing the occlusion of the external iliac and common iliac veins (red circle) which is consistent with VDS findings
VDS: venous duplex scan
Figure 4
Figure 4. Thrombus removed after suction thrombectomy with chronic clot noted at the top of the picture and more acute clot noted toward the bottom
Figure 5
Figure 5. Venogram after thrombectomy showing good flow and decreased clot burden in the external and common iliac veins (A) as well as good contrast flow through the IVC (B)
IVC: inferior vena cava
Figure 6
Figure 6. Left AKA stump during the postoperative course after significant non-viable soft tissue loss
AKA: above-knee amputation
See this image and copyright information in PMC

References

    1. Phlegmasia cerulea dolens following internal hemipelvectomy: case report and literature review. Butterworth JA, Huynh TT, Lewis VO, Chang EI. Injury. 2020;51:68–70. - PubMed
    1. Venous thromboembolism prophylaxis using the Caprini score. Golemi I, Salazar Adum JP, Tafur A, Caprini J. Dis Mon. 2019;65:249–298. - PubMed
    1. Phlegmasia cerulea dolens with compartment syndrome. Chaochankit W, Akaraborworn O. Ann Vasc Dis. 2018;11:355–357. - PMC - PubMed
    1. Gardella L, Faulk J. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2022. Phlegmasia alba and cerulea dolens. - PubMed
    1. The ugly face of deep vein thrombosis: phlegmasia cerulea dolens-case report. ELsaid AS, AlQattan AS, Elashaal E, AlSadery H, AlGhanmi I, Aldhafery BF. Int J Surg Case Rep. 2019;59:107–110. - PMC - PubMed

Publication types

LinkOut - more resources