II. Pathophysiology
- Phlegmasia (milk leg)
- Venous outflow obstruction
- Typically left sided due to left common iliac vein course beneath the left common iliac artery
- Progression along a spectrum
- Phlegmasia Alba Dolens
- Phlegmasia Cerulea Dolens
- Venous Gangrene
- Venous outflow obstruction
- Phlegmasia Alba Dolens (Milk Leg Syndrome)
- Pale white, painful, severely edematous extremity (milk leg)
- Proximal deep vein obstruction with patent collateral veins
- Phlegmasia Cerulea Dolens (Copper Leg Syndrome)
- Cyanotic or blue, severely edematous extremity (Copper leg) with obstructed collateral veins
- Pain out of proportion to appearance
- Like Alba Dolens, Cerulea Dolens is associated with proximal deep vein obstruction
- However, collateral or superficial veins are also obstructed leading to greater venous obstruction and Cyanosis
- Venous Gangrene
- Thrombosis extends into the capillaries
- Associated with Septic Shock and need for Limb Amputation
-
May-Thurner Syndrome
- Left common iliac vein compressed by right femoral artery and spurring from Vertebrae
- Presents with unilateral left Leg Edema and venous Hypertension
III. Causes
- Ilio-femoral Deep Vein Thrombosis
- Malignancy
- Hypercoagulable State
- Trauma
- Anatomic Compression
- May-Thurner Syndrome (typically left-sided)
- Pregnancy
IV. Differential Diagnosis
V. Imaging
- Extremity CT Venogram (preferred)
- Extremity MR Venogram
VI. Management
- Vascular surgery Consultation in all cases
- Phlegmasia Alba Dolens
- Medical management in most cases (if DVT)
- Phlegmasia Cerulea Dolens
- Emergent surgical thrombectomy or
- Emergent directed Thrombolytics
VII. Prognosis
- Untreated Phlegmasia (esp. cerulea) is associated with very high mortality (20 to 50%)
VIII. References
- Jhun and Herbert in Herbert (2014) EM:Rap 14(5): 8
- Jean-Louis and Sethuraman (2023) Crit Dec Emerg Med 37(7): 4-11
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Related Studies
| Definition (MSH) | Inflammation that is characterized by swollen, pale, and painful limb. It is usually caused by DEEP VEIN THROMBOSIS in a FEMORAL VEIN, following PARTURITION or an illness. This condition is also called milk leg or white leg. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D013924 |
| SnomedCT | 66923004 |
| Portuguese | Flegmasia Alba Dolens, Phlegmasia alba dolens |
| Spanish | Flegmasia Alba Dolens, Flegmasia alba dolens, flegmasía alba dolorosa, pierna blanca dolorosa, pierna de leche, flegmasia alba dolens, flegmasia alba dolens (trastorno), flegmasía alba dolorosa (trastorno), leucoflegmasia dolorosa, leucoflegmasía dolorosa, flegmasia alba dolorosa |
| French | Phlegmasia alba dolens, Phlegmatia alba dolens |
| German | Phlegmasia alba dolens |
| Dutch | phlegmasia alba dolens, alba dolens; phlegmasia, phlegmasia; alba dolens, Phlegmasia alba dolens |
| Japanese | ﾕｳﾂｳｾｲﾊｸｺｼｭ, 有痛性白股腫 |
| Czech | Phlegmasia alba dolens, phlegmasia alba dolens |
| Italian | Flegmasia alba dolens, Phlegmasia alba dolens |
| English | legs white, leg white, phlegmasia alba dolens, Dolens, Phlegmasia Alba, phlegmasia alba dolens (diagnosis), Milk leg syndrome, Phlegmasia alba dolens, White leg, Phlegmasia alba dolens (disorder), phlegmasia; alba dolens, alba dolens; phlegmasia, white leg, Phlegmasia Alba Dolens |
| Hungarian | Phlegmasia alba dolens |
| Norwegian | Phlegmasia alba dolens |
Ontology: Phlegmasia cerulea dolens (C0238367)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 66877004 |
| English | PHLEGMASIA CERULEA DOLENS, Phlegmasia caerulea dolens, phlegmasia cerulea dolens, phlegmasia cerula dolens, venous thrombosis deep vessels of lower extremity phlegmasia cerulea dolens, Phlegmasia cerulea dolens (diagnosis), Phlegmasia cerulea dolens, Blue phlebitis, Phlegmasia caerula dolens, Phlegmasia cerula dolens, Phlegmasia cerulea dolens (disorder), cerulea dolens; phlegmasia, phlegmasia; cerulea dolens |
| Dutch | flegmasia cerulea dolens, flegmasia caerulea dolens, cerulea dolens; phlegmasia, phlegmasia; cerulea dolens |
| French | Phlegmatia coerulea dolens, Phlegmatia caerulea dolens |
| German | Phlegmasia coerulea dolens, Phlegmasia cerulea dolens |
| Italian | Flegmasia cerulea dolens |
| Portuguese | Flegmasia cerulea dolens, Flegmasia caerulea dolens |
| Spanish | Flegmasía cerulea dolens, Flegmasia cerúlea dolens, flegmasia cerúlea dolens (trastorno), flegmasia cerúlea dolens, flegmasia cerúlea dolorosa, flegmasia cerúlea dolorosa (trastorno), pierna dolorosa azul |
| Japanese | 有痛性青股腫, ﾕｳﾂｳｾｲｾｲｺｼｭ |
| Czech | Phlegmasia caerulea dolens, Phlegmasia cerulea dolens |
| Hungarian | Phlegmasia cerulea dolens, Phlegmasia caerulea dolens |
Ontology: alba dolens; phlegmasia, nonpuerperal (C1408363)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 155454004, 266328001 |
| English | Milk-leg, non puerperal, nonpuerperal; milk leg, phlegmasia; alba dolens, nonpuerperal, alba dolens; phlegmasia, nonpuerperal |
| Dutch | alba dolens; phlegmasia, niet-puerperaal, niet-puerperaal; kraambeen, phlegmasia; alba dolens, niet-puerperaal |
