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[Phlegmasia cerulea dolens].
Ann Dermatol Venereol 2014; 141(11):682-4AD

Abstract

BACKGROUND

Herein we report a case of phlegmasia cerulea dolens, a form of venous thrombosis complicated by arterial ischaemia.

PATIENTS AND METHODS

A 69-year-old man presented a bilateral trophic condition of the lower limbs that had appeared 3 weeks earlier. The patient had a history of metastatic urothelial bladder carcinoma and arteritis. Clinical examination revealed right leg ulcers with massive bilateral oedema of the lower limbs, cyanosis and local ischaemia. Doppler ultrasound revealed bilateral and proximal deep vein thrombosis (sural and superficial femoral veins of the right leg; sural and iliac veins of the left leg) without any distal arterial flow. We concluded on a diagnosis of bilateral phlegmasia cerulea dolens.

DISCUSSION

Phlegmasia cerulea dolens is a particular type of deep venous thrombosis in which a proximal venous thrombus is combined with arterial ischaemic signs due to brutal and massive oedema and slowing down of arterial flow. In most cases, the lower limbs are involved, with malignancy being the most common cause. It should be suspected in the presence of the classical triad of "pain, oedema and cyanosis", with confirmation by Doppler ultrasound. There is no general consensus regarding standard management. Traditionally, systemic anticoagulation has been the mainstay of treatment for this condition. Endovascular surgery may be a possibility in some cases. Prompt diagnosis and rapid treatment initiation are paramount in order to improve the prognosis of this severe condition with ominous prospects.

Authors+Show Affiliations

Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.Laboratoire d'explorations vasculaires, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.Service de chirurgie thoracique et vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France. Electronic address: emmanuel.mahe@ch-argenteuil.fr.

Pub Type(s)

Case Reports
Journal Article

Language

fre

PubMed ID

25442472

Citation

Zeboulon, C, et al. "[Phlegmasia Cerulea Dolens]." Annales De Dermatologie Et De Venereologie, vol. 141, no. 11, 2014, pp. 682-4.
Zeboulon C, Amy de la Bretèque M, Bilan P, et al. [Phlegmasia cerulea dolens]. Ann Dermatol Venereol. 2014;141(11):682-4.
Zeboulon, C., Amy de la Bretèque, M., Bilan, P., Sin, C., Linder, J. F., Dakhil, B., ... Mahé, E. (2014). [Phlegmasia cerulea dolens]. Annales De Dermatologie Et De Venereologie, 141(11), pp. 682-4. doi:10.1016/j.annder.2014.06.009.
Zeboulon C, et al. [Phlegmasia Cerulea Dolens]. Ann Dermatol Venereol. 2014;141(11):682-4. PubMed PMID: 25442472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Phlegmasia cerulea dolens]. AU - Zeboulon,C, AU - Amy de la Bretèque,M, AU - Bilan,P, AU - Sin,C, AU - Linder,J-F, AU - Dakhil,B, AU - Sigal,M-L, AU - Mahé,E, Y1 - 2014/08/12/ PY - 2014/02/03/received PY - 2014/04/01/revised PY - 2014/06/19/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/7/22/medline KW - Arterial thrombosis KW - Leg ulcers KW - Paraneoplastic syndromes KW - Phlegmasia cerulea dolens KW - Phlébite bleue KW - Syndrome paranéoplasique KW - Thrombose artérielle KW - Thrombose veineuse KW - Ulcère des membres inférieurs KW - Venous thrombosis SP - 682 EP - 4 JF - Annales de dermatologie et de venereologie JO - Ann Dermatol Venereol VL - 141 IS - 11 N2 - BACKGROUND: Herein we report a case of phlegmasia cerulea dolens, a form of venous thrombosis complicated by arterial ischaemia. PATIENTS AND METHODS: A 69-year-old man presented a bilateral trophic condition of the lower limbs that had appeared 3 weeks earlier. The patient had a history of metastatic urothelial bladder carcinoma and arteritis. Clinical examination revealed right leg ulcers with massive bilateral oedema of the lower limbs, cyanosis and local ischaemia. Doppler ultrasound revealed bilateral and proximal deep vein thrombosis (sural and superficial femoral veins of the right leg; sural and iliac veins of the left leg) without any distal arterial flow. We concluded on a diagnosis of bilateral phlegmasia cerulea dolens. DISCUSSION: Phlegmasia cerulea dolens is a particular type of deep venous thrombosis in which a proximal venous thrombus is combined with arterial ischaemic signs due to brutal and massive oedema and slowing down of arterial flow. In most cases, the lower limbs are involved, with malignancy being the most common cause. It should be suspected in the presence of the classical triad of "pain, oedema and cyanosis", with confirmation by Doppler ultrasound. There is no general consensus regarding standard management. Traditionally, systemic anticoagulation has been the mainstay of treatment for this condition. Endovascular surgery may be a possibility in some cases. Prompt diagnosis and rapid treatment initiation are paramount in order to improve the prognosis of this severe condition with ominous prospects. SN - 0151-9638 UR - https://www.unboundmedicine.com/medline/citation/25442472/[Phlegmasia_cerulea_dolens]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0151-9638(14)00480-3 DB - PRIME DP - Unbound Medicine ER -