Phlegmasia cerulea dolens

Phlegmasia cerulea dolens (PCD) is an uncommon complication of deep venous thrombosis, which results from extensive thrombotic occlusion of the major and collateral veins of an extremity (usually the legs).

Left leg is more commonly affected than the right 4.

Risk factors for progression of deep venous thrombosis to phlegmasia cerulea dolens:

It is characterized by a clinical triad of acute limb swelling, cyanosis and severe acute pain.

Complete/near-complete thrombotic occlusion of the venous drainage of the limb leads to massive fluid stasis and edema, and a secondary compartment syndrome with obstruction of arterial supply, and ultimately ischemic injury.

Doppler ultrasound will support the diagnosis demonstrating massive superficial and deep venous thrombotic subtotal/total occlusion.

  • IV heparin
  • angioplasty +/- stenting
  • catheter-directed thrombolysis
  • surgical thrombectomy
  • significant risk of massive pulmonary embolism, even with anticoagulation
  • 40-60% develop gangrene of the periphery 3
    • due to increased compartmental pressures from severe venous congestion and edema
  • 20-50% mortality 3
  • amputation rate as high as 25% in survivors 4

From the Ancient Greek for "inflamed blue edema".

Share article

Article information

rID: 57012
System: Vascular
Section: Syndromes
Synonyms or Alternate Spellings:
  • Phlegmasia alba dolens

Support Radiopaedia and see fewer ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.