Phlegmasia cerulea dolens: rare complication of vena cava filter placement in man with paraplegia.
OBJECTIVE
To describe a complication of placement of an inferior vena cava (IVC) filter in a man with paraplegia.


METHODS
Case report.


METHODS
A 48-year-old man with T11 paraplegia secondary to an L1 burst fracture underwent thoracic spinal fusion. The postoperative course was complicated by deep vein thrombosis (DVT) of the right common femoral vein, which was treated with warfarin.


RESULTS
During rehabilitation, the hematocrit declined, and fluctuance was noted along the surgical site. Computed tomographic scan suggested a hematoma in the paraspinal and latissimus dorsi muscles. Warfarin was discontinued, and an IVC filter was placed. He subsequently developed severe leg pain, followed by hypotension, acute renal failure, and compartment syndrome in bilateral lower extremities requiring fasciotomies. Ultrasound and computed tomographic angiogram showed extensive bilateral lower extremity DVTs and pulmonary emboli. The diagnosis of cerulea dolens was made. Mechanical and pharmacological thrombectomy was aborted secondary to bleeding complications and hypotension. The patient died shortly after care was withdrawn at the family's request. The autopsy revealed multiple thrombi in IVC, bilateral pelvic and femoral veins, and left pulmonary artery embolus, consistent with phlegmasia cerulea dolens.


CONCLUSIONS
Inferior vena cava filters may prevent pulmonary embolism but do not affect the underlying thrombotic process. An IVC filter should be recognized as a possible thrombogenic nidus in patients with spinal cord injury who have known DVT.
Shem
Kazuko
K
Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California 95128, USA. kazuko.shem@hhs.sccgov.org
D000925:Anticoagulants / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D013119:Spinal Cord Injuries / Q000150:complications*; D016103:Spinal Fractures / Q000150:complications; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016306:Vena Cava Filters / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin