Deep Vein Thrombosis Case Study

Patient comes into the Emergency Room with a chief complaint of swelling and extreme pain in the left leg. After awaiting triage, the patient is finally seen by the physician. Temperature 96.8˚F, Heart Rate 129 beats per minute, Blood Pressure 102/60, Respiratory Rate 23, SPO2 100% on room air. Upon examination of his left leg, it is undeniably blue in color with significant swelling as compared to the right. Superficial veins are noticeably distended and the leg is cool to the touch. A Duplex Ultrasonography Examination is performed and a large deep vein thrombosis (DVT) is noted, involving the Common Femoral Vein all the way to the Popliteal Vein. At this point and stage, it is determined to be Phlegmasia Cerulea Dolens (PCD) and deemed …show more content…
Phlegmasia Cerulea Dolens, literally translated as painful blue edema, is a rare complication of Deep Vein Thrombosis. Deep Vein Thrombosis itself is defined as a blood clot in a deep vein in your body, commonly in the lower extremities. If left untreated, it may progress along a continuum from deep vein thrombosis, to Phlegmasia Alba Dolens (PAD), into Phlegmasia Cerulean Dolens, finally ending in gangrene. Phelgmasia Alba Dolens is extensive thrombosis occluding major deep venous channels. Subsequent compromise of arterial flow causes edema, pain, and a white appearance (alba) of the extremity. What differentiates PCD from PAD is occlusion extending into collateral veins. This results in worsening venous congestion, leading to acute significant edema. Blood pools in the lower extremity as venous return is diminished. Intravascular fluid dwindles and the patient becomes hypotensive, tachycardic, and urine output is decreased. Ischemia persists and the affected limb becomes cyanotic. With progression, cyanosis increases and the patient begins to form bullae, paresthesia, weakness, and compartment syndrome. In 40% - 60% of cases, there is arterial and venous capillary