Phlegmasia Cerulea Dolens in the Upper Extremity: A Case Report and Literature Review

Zhang, Jie; Wang, Yanyang; Du, Yali; Zhao, Liang

doi:10.1016/j.avsg.2021.04.042

Cited by 3 publications

(12 citation statements)

References 6 publications

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“…It is also worth noted that our patient was complicated with supra vena cava thrombosis, which was not reported in previous upper extremity PCD cases or cohort. Meanwhile, only few cases reported simultaneous upper extremity arterial thrombosis, in our case, right radial, ulnar and part of branchial artery thrombosis occurred simultaneously with right upper limb PCD ( 1 , 3 , 17 ). The authors believed that these complications aggravated the clinical manifestations of our patient and lead to worse outcome.…”

Section: Discussionmentioning

confidence: 61%

“…DVT can result in partial or total outflow obstruction of venous system, leading to severe consequences. PCD represents the most extreme manifestation of DVT, which could lead to severe edema, pain, venous hypertension, intestinal pressure elevation and compartment syndrome in extremity and ultimately progress to arterial thrombosis and venous gangrene ( 1 – 3 , 6 ). Current medical literature regarding PCD were mostly case reports and there is no literature that oversaw the exact incidence of PCD due to its rarity and lack of cohort study ( 3 , 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, early diagnosis and intervention of PCD is vital as PCD progresses rapidly and may result in ischemic events and the need for amputation ( 3 ). Currently, most reported PCD cases were described in the lower extremities, while only 2%–5% of PCD occurred in the upper extremities ( 1 , 3 – 5 ). We herein present a case of upper extremity PCD involving supra vena cava and pulmonary embolism, who presented with massive edema, severe pain and venous gangrene of right hand and forearm.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Ge,

Weng,

Zhao

et al. 2024

Front. Cardiovasc. Med.

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Phlegmasia cerulea dolens (PCD) is a rare yet severe complication of deep vein thrombosis (DVT), characterized by a high amputation rate and mortality. Early diagnosis and treatment are crucial in managing this condition. PCD predominantly affects the lower extremities rather than the upper extremities. We herein present a rare upper extremity PCD case accompanied with supra vena cava and pulmonary embolism in a cervical cancer patient, who presented to our institution with severe pain, edema and irreversible venous gangrene of right upper limb with no response to anticoagulation therapy. Emergency fasciotomy and amputation were performed due to the progressed venous gangrene, however, the patient developed severe infection and coagulation disorders, gastrointestinal bleeding and disseminated intravascular coagulation after the surgery. Despite medical interventions, her family chose to withdraw treatment and the patient died in ICU at the fourth day following emergency surgery.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Ge,

Weng,

Zhao

et al. 2024

Front. Cardiovasc. Med.

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“…Dentro de los factores que predisponen al desarrollo de FCD se tienen los mismos que inducen la fisiopatología de la TVP; es decir, aquellas situaciones que lleven a estasis, hipercoagulabilidad, y lesión endotelial (9,12,13). Dentro de los factores de riesgo se encuentran: malignidades, enfermedad cardiovascular, cirugías recientes, inmovilidad, obesidad, trastornos de la coagulación, presencia de una catéter venoso central e infección por COVID-19; esto debido a su asociación con estados de hipercoagulabilidad (9,10,11). A pesar de la fuerte asociación entre estos factores y el desarrollo de la FCD, del 10-16% de los pacientes afectados no presenta ninguno de estos (7).…”

Section: Epidemiología Y Factores De Riesgounclassified

“…La FCD se produce por la instauración de una trombosis u obstrucción aguda y masiva de un territorio venoso, lo cual lleva a un enlentecimiento secundario del flujo linfático del miembro afectado (5,11). También ocurre una acumulación de líquido intersticial, y por ende un aumento de la presión hidrostática a nivel capilar y venoso.…”

Section: Fisiopatologíaunclassified

Flegmasia cerulea dolens: una presentación olvidada de trombosis venosa profunda

2022

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La flegmasia cerúlea dolens es una complicación poco común pero potencialmente mortal de la trombosis venosa profunda. Esta ocurre más comúnmente entre los 40 y los 60 años, principalmente en mujeres y en personas con condiciones que conduzcan a un estado de hipercoagulabilidad, estasis y alteraciones del flujo sanguíneo. Se caracteriza por la aparición súbita de edema, dolor y cianosis en la extremidad afectada, y es más común en el miembro inferior izquierdo por la compresión ejercida por la arteria ilíaca común sobre la vena ilíaca. Con respecto a su fisiopatología, se le atribuye principalmente a una elevación de la presión intersticial e hipovolemia que conducen a un compromiso de la perfusión arterial, y posteriormente necrosis y gangrena. Su diagnóstico se basa en la sospecha clínica, y se puede confirmar por la presencia de un proceso trombótico venoso mediante ultrasonido doppler; sin embargo, el gold standard para su diagnóstico continúa siendo la venografía guiada por catéter. No existe un tratamiento único establecido para la flegmasia cerúlea dolens pero existe consenso en que su abordaje debe de ser rápido y multidisciplinario, debido al alto riesgo de amputaciones y mortalidad asociadas. Entre los tratamientos existentes se encuentran métodos invasivos, tanto quirúrgicos como percutáneos; y no invasivos, por medio de anticoagulación y fibrinólisis sistémica.

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Interventional Therapy for Upper Extremity Phlegmasia Cerulea Dolens in a Patient With Heparin-Induced Thrombocytopenia: A Case Report

Hidalgo Oviedo,

Muñoz Durán,

Muñoz-Caicedo

et al. 2024

Cureus

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This article presents a case of a multimorbid 63-year-old woman with chronic kidney disease and heparininduced thrombocytopenia (HIT). Following the insertion of a central venous catheter, she developed phlegmasia cerulea dolens (PCD) in her left arm, a rare and severe complication of deep vein thrombosis (DVT). Given the severity of the case, adapting to anticoagulant contraindications or unavailability, management with catheter-directed thrombolysis and mechanical thrombectomy was made. It is concluded that catheter-directed thrombolysis and mechanical thrombectomy are valuable therapeutic alternatives in critical situations where treatment options are limited.

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Phlegmasia Cerulea Dolens in the Upper Extremity: A Case Report and Literature Review

Cited by 3 publications

References 6 publications

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Flegmasia cerulea dolens: una presentación olvidada de trombosis venosa profunda

Interventional Therapy for Upper Extremity Phlegmasia Cerulea Dolens in a Patient With Heparin-Induced Thrombocytopenia: A Case Report

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