Phlegmasia Cerulea Dolens (Deep Vein Thrombosis)

This is an answer to the Case – Unilateral Leg Swelling and Bluish Discoloration

An 85-year-old woman with newly diagnosed metastatic non–small-cell lung cancer was admitted for pain control. Two days after admission, bluish discoloration of the left great toe was noted.

Doppler ultrasonography revealed a left femoropopliteal deep-vein thrombosis.

Anticoagulation with heparin was initiated, but there was progressive swelling and cyanosis of the leg. The patient was referred for prophylactic placement of an inferior vena cava filter.

Fluoroscopy revealed that the clot had extended into the left iliac vein and lower inferior vena cava. Filter placement was successful. However, despite continued intravenous anticoagulation and attempts at mechanical thrombectomy, the clinical findings progressed to venous gangrene.

Phlegmasia cerulea dolens (blue, painful leg) is an uncommon manifestation of deep-vein thrombosis and results from massive thrombosis compromising venous outflow, which causes ischemia.