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Case Report
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| Phlegmasia cerulea dolens complicated by methylenetetrahydrofolate reductase genetic mutation | ||||||
| Jason A. Fried1, Lauren M. Wright2 | ||||||
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1DO, USA Division Chief of General Surgery at Western Reserve Hospital, Cuyahoga Falls Surgical Associates, Cuyahoga Falls, OH.
2DO, General Surgery Resident, Western Reserve Hospital Cuyahoga Falls, OH, USA. | ||||||
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| How to cite this article |
| Fried JA, Wright LM. Phlegmasia cerulea dolens complicated by methylenetetrahydrofolate reductase genetic mutation. Int J Case Rep Imag 2016;7(5):314–317. |
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Abstract
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Introduction:
Deep venous thrombosis (DVT) is the formation of a blood clot within a deep vein. Phlegmasia cerulea dolens (PCD) represents a critical acute consequence of DVT. The PCD is a condition caused by massive iliofemoral thrombosis that produces severe venous congestion and obstruction of arterial flow; eventually, causing ischemia in the affected extremity. The treatment goals of PCD are to restore venous outflow by removing thrombus burden, prevent additional thrombus formation, and maintain collateral circulation. However, no therapeutic algorithms exist for PCD.
Case Report: We report PCD in a 55-year-old male with a significant past medical history for multiple venous thromboembolisms, requiring placement of an inferior vena cava filter and lifetime anticoagulation. Clinical presentation and accompanying venous duplex results led to the diagnosis of PCD. The 9th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy created guidelines for treatment of acute DVT in the absence of gangrene. Guidelines advise to withhold thrombolysis and percutaneous or surgical procedure until treatment with therapeutic heparin anticoagulation proves to be inadequate. Conservative treatment with therapeutic anticoagulation was unsuccessful. therefore, catheter directed thrombolytic therapy, venoplasty, and stent placement were implemented. Conclusion: Due to possible associated morbidity and mortality, it is recommended to implement therapy soon after diagnosis of PCD. It is hoped that this report will provide guidance in management and assist to develop an evidence-based treatment algorithm for PCD. | |
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Keywords:
Deep venous thrombosis, Hypercoagulable, Phlegmasia cerulea dolens, Thrombolysis
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Author Contributions
Jason Fried – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising report critically for important intellectual content, Final approval of the version to be published Lauren Wright – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Jason Fried et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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