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A Novel Non-invasive Method for the Detection of Elevated Intra-compartmental Pressures of the Leg
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Phlegmasia cerulea dolens causing compartment syndrome
Baturay Aydemir1, Connor Hoyle2, Wael Hakmeh1
1Department of Emergency Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, United States of America.
The American Journal of Emergency Medicine
|August 12, 2022
Summary
Phlegmasia cerulea dolens (PCD) is a rare condition causing severe limb swelling and pain due to deep vein thrombosis. Prompt treatment, including IV Lidocaine for pain and thrombolysis, can lead to full recovery and prevent limb loss.
Area of Science:
- Vascular Surgery
- Emergency Medicine
- Anesthesiology
Background:
- Phlegmasia cerulea dolens (PCD) is a rare, severe form of deep venous thrombosis (DVT) affecting proximal iliofemoral veins.
- Characterized by a swollen, cyanotic extremity, PCD has high mortality (20-40%) due to compromised venous drainage.
- Rapid increases in compartment pressure can occur, though arterial compromise is uncommon.
Observation:
- A middle-aged woman presented with a severely painful, blue, swollen left leg unresponsive to opioids.
- Intravenous (IV) Lidocaine effectively alleviated her intractable pain.
- The patient was diagnosed with PCD leading to compartment syndrome in her left leg.
Findings:
- Catheter-directed thrombolysis and emergent thrombectomy were performed.
- The patient, initially experiencing motor dysfunction, regained motor function post-intervention.
- Successful treatment resulted in a full recovery without irreversible limb ischemia.
Implications:
- PCD with compartment syndrome is a rare but critical emergency requiring prompt recognition.
- Early intervention is crucial to prevent limb ischemia, morbidity, and mortality.
- IV Lidocaine may serve as an effective analgesic option in managing PCD pain.
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