Massive iliofemoral DVT with limb ischemia, suspected phlegmasia
Recommended: Lower extremity Doppler US + CT/MR Venography is the preferred imaging study for massive iliofemoral dvt with limb ischemia, suspected phlegmasia. Phlegmasia alba (white, painful, swollen) → cerulea dolens (blue, ischemic) → venous gangrene.
Recommended study
Lower extremity Doppler US + CT/MR Venography
Phlegmasia alba (white, painful, swollen) → cerulea dolens (blue, ischemic) → venous gangrene. Life-and-limb-threatening.
If the default doesn't apply
Catheter-directed thrombolysis candidate
Venography + IR for CDT / thrombectomy
IV contrast
Watch-outs
Limb-threatening emergency
Aggressive intervention (CDT, mechanical thrombectomy, fasciotomy) to save limb.
Underlying malignancy
Phlegmasia in malignancy is poor prognostic sign; balance intervention vs comfort.
Pearls
- Alba dolens: painful, swollen, pale limb from massive DVT (no cyanosis, no ischemia). Cerulea dolens: blue limb with ischemia from near-complete venous outflow obstruction and compartment-level pressures — can progress to venous gangrene.
- Mortality 25-40%, amputation 20-50% even with treatment.
- Catheter-directed thrombolysis + balloon thrombectomy improves limb salvage.