C73. Phlegmasia Cerulea Dolens "A Case of the Blue Leg": Act Properly, Avoid Morbidity and Mortality

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Abstract Background Deep vein thrombosis (DVT) may compromise venous outflow from a limb, causing significant swelling. Phlegmasia cerulea dolens (PCD) is a severe presentation of massive DVT. PCD is a medical emergency that can lead to venous gangrene of the lower extremity. Early diagnosis and prompt treatment are crucial for limb salvage. Case Presentation We report 65-year-old woman presented with acute onset edema and pain in left leg. Left lower limb examination found edema from the left groin to the distal left extremity, marmorata, and bullae with cold palpation. Sensoric and motoric function of left leg were decrease. Duplex ultrasonography showed thrombus and non compressible in left common femoral vein (CFV). We have done systemic thrombolytic using streptokinase 250.000 IU. However, the condition of the patient didn’t improve. The patient then underwent surgical thrombectomy procedure with a forgaty catheter. There was a ± 20 cm of thrombus. Her left lower limb became warm after thrombectomy and her symptoms improved. Finally, after 12 days hospitalization the patient was discharged and give anticoagulant therapy. Conclusion Although uncommon, it is important to identify patients with PCD because they should be considered for more aggressive management. Intravenous anticoagulant is one of therapeutic strategy while a decision to pursue more aggressive therapy is being considered. Patients with extensive DVT but without signs of PCD do not routinely receive thrombolysis but should be anticoagulated and monitored closely for the development of PCD.

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