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
- Painful white leg
- Proximal deep vein obstruction
- Phlegmasia Cerulea Dolens
- Triad of painful blue leg with edema
- Pain out of proportion to appearance
- Deep vein and collateral or superficial vein obstruction
- Results in venous congestion (edema) which distinguishes it from Phlegmasia Alba Dolens
- Triad of painful blue leg with edema
- Venous Gangrene
- Thrombosis extends into the capillaries
- May-Thurner Syndrome
- Left common iliac vein compressed by right femoral artery
- Presents with unilateral left Leg Edema and venous Hypertension
- Increased risk of left Deep Vein Thrombosis
- Diagnosed via Magnetic Resonance Venography (MRV)
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. References
- Jhun and Herbert in Herbert (2014) EM:Rap 14(5): 8