Hypercoagulability Due to COVID-19 Leading to Impending Phlegmasia Cerulea Dolens and Sub-Massive Bilateral Pulmonary...

Area of Science:

• Vascular Medicine
• Infectious Disease
• Interventional Radiology

Background:

• Coronavirus disease 2019 (COVID-19) is associated with hypercoagulable states.
• Venous thromboembolism is a known complication of COVID-19.

Observation:

• A 47-year-old male with hypertension and pre-diabetes presented with acute dyspnea and unilateral leg swelling post-COVID-19 infection.
• Clinical examination and ultrasound revealed extensive deep and superficial lower extremity venous thrombosis extending to the inferior vena cava (IVC).
• The patient was diagnosed with impending phlegmasia cerulea dolens and showed signs suggestive of pulmonary embolism on V/Q scan.

Findings:

• Extensive lower extremity deep vein thrombosis (DVT) and superficial venous thrombosis involving the inferior vena cava (IVC).
• Widespread ventilation/perfusion (V/Q) mismatch indicating pulmonary embolism.
• Successful management with catheter-directed alteplase and IVC filter placement.

Implications:

• This case highlights the potential for severe venous thromboembolism in COVID-19 patients.
• Early recognition and aggressive interventional management are crucial for favorable outcomes.
• Highlights the role of interventional radiology in managing complex venous thromboembolic events.