View source for Phlegmasia alba dolens

==Background==
*"Milk/White Leg"
*Massive iliofemoral occlusion due to venous thromboembolism
*Spares collateral veins
*Lack of venous congestion

{{Venous thromboembolism types}}

===Risk Factors===
*Age 50-60s
*Malignancy (20-40%)
*[[Pregnancy]]
*Inherited thrombophilia
*[[Trauma]]/surgery
*10% idiopathic in patients without risk factors

==Clinical Features==
*Pain
*Edema
*White appearance/blanching (alba)
*May progress to [[phlegmasia cerulea dolens]]
**Superficial venous system is occluded, resulting in no venous outflow

==Differential Diagnosis==
*Arterial embolism
*[[Phlegmasia cerulea dolens]]
*[[DVT]]
*[[Cellulitis]]
*[[Lymphedema]]
*Venous valvular insufficiency
*[[Superficial thrombophlebitis]]
{{Template:Calf pain DDX}}

==Evaluation==
*Clinical diagnosis
*Duplex [[Ultrasound: DVT|US]]
*Contrast venography
*MRV

==Management==
*Conservative management
**Steep limb elevation
**Fluid resuscitation
**[[Heparin]]: 80-100U/kg followed by infusion of 15-18U/kg/hr
**Vascular surgery consult
*If conservative therapy fails, can consider:
**[[Thrombolysis]]: Alteplase (1mg/min to total of 50mg) distal to thrombus
**Interventional radiology consult for emergent catheter-directed thrombolysis
**Thrombectomy

==Disposition==
*Admit

==References==
<references/>

[[Category:Cardiology]]
[[Category:Vascular]]