Phlegmasia cerulea dolens

Introduction

Phlegmasia cerulea dolens (PCD, painful blue leg) is a rare manifestation of deep vein thrombosis. It is a medical emergency and can rapidly lead to venous gangrene of the extremity.1 Early bedside diagnosis is crucial in order to allow time for interventions to salvage the limb.

Case report

A 58-year-old woman with metastatic breast cancer presented with acute onset of pain in her right lower leg for 1 day. The pain was constant, non-radiating, throbbing, and worsened over a few hours to a 9/10. The patient denied any prior history of foot surgery. On physical examination, she had severe cachexia and pitting oedema in the right lower leg, with purple discolouration and mottling of the toes (figure 1). Dorsalis pedis and posterior tibialis pulses were palpable and equal on both sides. Her platelet count and coagulation profile were within normal limits. Doppler ultrasound of the lower extremity...

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