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Phlegmasia Cerulea Dolens: A New Perspective on Management
Harry G Sequeira Gross1, Yomary Jimenez2, Camelia Ciobanu2
1Internal Medicine, St. Barnabas Hospital, The Bronx, USA.
Cureus
|August 10, 2021
Summary
Phlegmasia cerulea dolens (PCD) in a Rutherford category IIb patient unexpectedly resolved with short-term heparin. This case suggests prompt anticoagulation may avoid surgical intervention for PCD.
Area of Science:
- Vascular Surgery
- Hematology
Background:
- Phlegmasia cerulea dolens (PCD) is a rare, severe form of deep vein thrombosis causing limb ischemia.
- Rutherford limb ischemia scale categorizes severity, with category IIb typically requiring aggressive surgical treatment.
Observation:
- A 58-year-old female presented with acute severe left leg pain and discoloration, diagnosed as PCD.
- Despite Rutherford category IIb, symptoms resolved rapidly after a one-hour heparin infusion.
Findings:
- Complete resolution of PCD symptoms was achieved with short-term anticoagulation.
- No thrombolysis or thrombectomy was necessary, highlighting the efficacy of prompt heparin administration.
Implications:
- This case suggests that prompt pharmacologic treatment with anticoagulation may be a viable alternative to surgery in eligible PCD patients.
- Early anticoagulation could potentially restore venous flow and prevent the need for invasive procedures in PCD.
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