Phlegmasia Cerulea Dolens

A 50 year old man, with a prior history of stage IV rectal cancer in palliative treatment, came to the Emergency Department with sudden severe pain of 12 h duration in the left lower extremity. On physical examination edema with fovea in the left lower extremity with cyanosis below the knee (Figs. 1 and 2, arrows) was found. No popliteal or distal pulse could be found, with anesthesia and paralysis of the left foot. A Doppler ultrasound showed deep venous thrombosis of the iliac, femoral and popliteal veins. Anticoagulation was started with low molecular weight heparin. The patient progressed to venous gangrene and died 4 days later.

Fig. 1

Fig. 2