Phlegmasia Alba and Cerulea Dolens Workup

Updated: Mar 08, 2022
  • Author: Cassius Iyad Ochoa Chaar, MD, MS, FACS; Chief Editor: Vincent Lopez Rowe, MD, FACS  more...
  • Print

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.