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Phlegmasia Alba and Cerulea Dolens Workup

  • Author: Cassius Iyad Ochoa Chaar, MD, MS, FACS; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Oct 12, 2015
 

Imaging Studies

Contrast venography is still considered the gold standard for the diagnosis of deep venous thrombosis (DVT), though at present, it is rarely used (only for diagnostic purposes). Duplex ultrasonography has replaced venography as the preferred imaging modality, with an accuracy exceeding 90%. Features suggestive of DVT on duplex ultrasonography are as follows:

  • Lack of compressibility of the vein
  • Lack of spontaneous flow
  • Increased vein diameter
  • Increased echogenicity within the lumen

The advantages of ultrasonography lie in its availability, portability, and noninvasive nature (which also avoids the need for radiation).

Computed tomography (CT) venography, and magnetic resonance (MR) venography are seldom used but can help determine the proximal and distal extents of the thrombus. They can also determine any anatomic abnormalities in the pelvis that may be compressing the iliac veins and precipitating thrombosis.

The diagnosis of phlegmasia alba dolens (PAD) or phlegmasia cerulaea dolens (PCD) is made on clinical grounds in patients who have extensive DVT on imaging.

 
 
Contributor Information and Disclosures
Author

Cassius Iyad Ochoa Chaar, MD, MS, FACS Assistant Professor of Surgery, Section of Vascular Surgery, Yale University School of Medicine

Cassius Iyad Ochoa Chaar, MD, MS, FACS is a member of the following medical societies: American College of Surgeons, American Venous Forum, Association for Academic Surgery, Eastern Vascular Society, European Society for Vascular Surgery, New England Society for Vascular Surgery, Society for Vascular Surgery, Vascular and Endovascular Surgery Society

Disclosure: Nothing to disclose.

Coauthor(s)

Alan Dardik, MD, PhD, FACS Associate Professor, Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine

Alan Dardik, MD, PhD, FACS is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Association of VA Surgeons, Phi Beta Kappa, Society for Vascular Surgery, American Society for Cell Biology, Vascular and Endovascular Surgery Society, Eastern Vascular Society, Society for Vascular Medicine, Society for Clinical Vascular Surgery

Disclosure: Nothing to disclose.

Savni Satoskar, MBBS Postdoctoral Fellow, Vascular Surgery Division, Yale School of Medicine

Savni Satoskar, MBBS is a member of the following medical societies: Indian Medical Association

Disclosure: Student Editor for: Elsevier.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Additional Contributors

William H Pearce, MD Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University, The Feinberg School of Medicine

William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, Western Surgical Association

Disclosure: Nothing to disclose.

Acknowledgements

Timothy Liem, MD Clinical Assistant Professor of Surgery, Oregon Health and Science University; Consulting Surgeon, Department of Surgery, Division of Vascular Surgery, Legacy Emanuel Hospital and Good Samaritan Hospitals

Disclosure: Nothing to disclose.

Dina Rahhal, MD Postdoctoral Fellow in Transplant Immunology, Institute for Cellular Therapeutics, University of Louisville

Disclosure: Nothing to disclose.

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Principal deep veins of the lower extremity.
 
 
 
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