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East Florida


HCA Florida St. Lucie Hospital


Family Medicine

Document Type


Publication Date



Phlegmasia Cerulea Dolens, deep vein thrombosis


Cardiovascular Diseases | Family Medicine | Medicine and Health Sciences


Introduction: This is the case of a patient presenting with phlegmasia cerulea dolens after recent travel with concurrent extensive pulmonary emboli. Patient’s symptoms progressed quickly, atypically, and he did not have known common risk factor for the extent of his disease.

Case Description: The patient is a 78-year-old Caucasian male who presented to the emergency department complaining of left leg swelling and mild pain that began 1 day prior. Patient flew in 3 weeks prior from Scotland. On exam, patient was found to have extensive erythema and ecchymosis of left leg. On admission, venous ultrasound showed complete extensive thrombosis of left lower extremity extending into common femoral, greater saphenous, superficial femoral, popliteal, and into visualized calf veins. CT Chest and abdomen pelvis showed thrombosis extended up into inferior vena cava and patient had extensive bilateral pulmonary emboli. Patient was started on heparin and scheduled for thrombectomy following morning. Overnight patient’s pain progressed until thrombectomy and angioplasty was performed. Patient was discharged on anticoagulation within two days with complete resolution of symptoms.

Discussion: This patient’s case demonstrates the importance of prompt treatment in Phlegmasia cerulea dolens as the rate of amputation is 20-50%. This patient’s risk factor of immobility due to travel is a less common risk factor for this complication of DVT and his symptoms did not correlate with the extent of the disease.

A Case of Phlegmasia Cerulea Dolens



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