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Phlegmasia alba dolens
From WikEM
Contents
Background
- "Milk/White Leg"
- Massive iliofemoral occlusion
- Spares collateral veins
- Lack of venous congestion
Clinical Spectrum of Venous thromboembolism
- Deep venous thrombosis (uncomplicated)
- Phlegmasia alba dolens
- Phlegmasia cerulea dolens
- Venous gangrene
- Pulmonary embolism
- Isolated distal deep venous thrombosis
Only 40% of ambulatory ED patients with PE have concomitant DVT[1][2]
Risk Factors
- Age 50-60s
- Malignancy (20-40%)
- Pregnancy
- Idiopathic (10%)
- Inherited thrombophilia
- Trauma/surgery
Clinical Features
- Pain
- Edema
- White appearance/blanching (alba)
- Progresses to phlegmasia cerulea dolens
- Superficial venous system is occluded, resulting in no venous outflow
Differential Diagnosis
- Arterial embolism
- Phlegmasia cerulea dolens
- DVT
- Cellulitis
- Lymphedema
- Venous valvular insufficiency
- Superficial thrombophlebitis
Workup
- Clinical diagnosis
- Duplex US
- Contrast venography
- MRV
Management
- Conservative management
- Steep limb elevation
- Fluid resuscitation
- Heparin: 80-100U/kg followed by infusion of 15-18U/kg/hr
- Vascular surgery consult
- If conservative therapy fails, can consider:
- Thrombolytic: Alteplase (1mg/min to total of 50mg) distal to thrombus
- Interventional radiology consult for emergent catheter-directed thrombolysis
- Thrombectomy
Disposition
- Admit
References
- ↑ Righini M, Le GG, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008; 371(9621):1343-1352.
- ↑ Daniel KR, Jackson RE, Kline JA. Utility of the lower extremity venous ultrasound in the diagnosis and exclusion of pulmonary embolism in outpatients. Ann Emerg Med. 2000; 35(6):547-554.
- Dardik A. (2014, Feb 25). Phlegmasia Alba and Cerulea Dolens. eMedicine. Retrieved 12/21/2014 from http://emedicine.medscape.com/article/461809-overview.
- Rosen's Emergency Medicine 8th edition. 2013. Chapter: Peripheral Arteriovascular Disease p. 1147.
- Lip GY, et al. Overview of the treatment of lower extremity deep vein thrombosis (DVT). In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 21, 2014.
