Phlegmasia alba dolens: Difference between revisions
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==Background== | ==Background== | ||
* "Milk/White Leg" | *"Milk/White Leg" | ||
* Massive iliofemoral occlusion | *Massive iliofemoral occlusion due to venous thromboembolism | ||
* Spares collateral veins | *Spares collateral veins | ||
* Lack of venous congestion | *Lack of venous congestion | ||
{{Venous thromboembolism types}} | {{Venous thromboembolism types}} | ||
==Risk Factors== | ===Risk Factors=== | ||
* Age 50-60s | *Age 50-60s | ||
* Malignancy (20-40%) | *Malignancy (20-40%) | ||
* Pregnancy | *[[Pregnancy]] | ||
*Inherited thrombophilia | |||
* Inherited thrombophilia | *[[Trauma]]/surgery | ||
* Trauma/surgery | *10% idiopathic in patients without risk factors | ||
==Clinical Features== | ==Clinical Features== | ||
* Pain | *Pain | ||
* Edema | *Edema | ||
* White appearance/blanching (alba) | *White appearance/blanching (alba) | ||
* | *May progress to [[phlegmasia cerulea dolens]] | ||
** Superficial venous system is occluded, resulting in no venous outflow | **Superficial venous system is occluded, resulting in no venous outflow | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Arterial embolism | *Arterial embolism | ||
* Phlegmasia cerulea dolens | *[[Phlegmasia cerulea dolens]] | ||
* DVT | *[[DVT]] | ||
* Cellulitis | *[[Cellulitis]] | ||
* Lymphedema | *[[Lymphedema]] | ||
* Venous valvular insufficiency | *Venous valvular insufficiency | ||
* Superficial thrombophlebitis | *[[Superficial thrombophlebitis]] | ||
== | {{Template:Calf pain DDX}} | ||
* Clinical diagnosis | |||
* Duplex US | ==Evaluation== | ||
* Contrast venography | *Clinical diagnosis | ||
* MRV | *Duplex [[Ultrasound: DVT|US]] | ||
*Contrast venography | |||
*MRV | |||
==Management== | ==Management== | ||
* Conservative management | *Conservative management | ||
** Steep limb elevation | **Steep limb elevation | ||
** Fluid resuscitation | **Fluid resuscitation | ||
** Heparin: 80-100U/kg followed by infusion of 15-18U/kg/hr | **[[Heparin]]: 80-100U/kg followed by infusion of 15-18U/kg/hr | ||
** Vascular surgery consult | **Vascular surgery consult | ||
* If conservative therapy fails, can consider: | *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 | **Interventional radiology consult for emergent catheter-directed thrombolysis | ||
** Thrombectomy | **Thrombectomy | ||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Vascular]] | [[Category:Vascular]] | ||
Latest revision as of 05:24, 27 September 2019
Background
- "Milk/White Leg"
- Massive iliofemoral occlusion due to venous thromboembolism
- Spares collateral veins
- Lack of venous congestion
Clinical Spectrum of Venous thromboembolism
- Deep venous thrombosis (uncomplicated)
- Phlegmasia alba dolens
- Phlegmasia cerulea dolens
- Venous gangrene
- Pulmonary embolism
- Isolated distal deep venous thrombosis
Only 40% of ambulatory ED patients with PE have concomitant DVT[1][2]
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
Calf pain
- Achilles tendon rupture
- Calcaneal bursitis
- Cellulitis
- Compartment syndrome
- Deep venous thrombosis (DVT)
- Distal leg fractures
- Gastrocnemius strain
- Ruptured popliteal cyst (Bakers cyst)
- Superficial thrombophlebitis
Evaluation
- Clinical diagnosis
- Duplex 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
- ↑ Righini M, Le GG, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008; 371(9621):1343-1352.
- ↑ Daniel KR, Jackson RE, Kline JA. Utility of the lower extremity venous ultrasound in the diagnosis and exclusion of pulmonary embolism in outpatients. Ann Emerg Med. 2000; 35(6):547-554.