title: [Phlegmasia cerulea dolens].
abstract: BACKGROUND
  Herein we report a case of phlegmasia cerulea dolens, a form of venous thrombosis complicated by arterial ischaemia.
  
  
  METHODS
  A 69-year-old man presented a bilateral trophic condition of the lower limbs that had appeared 3 weeks earlier. The patient had a history of metastatic urothelial bladder carcinoma and arteritis. Clinical examination revealed right leg ulcers with massive bilateral oedema of the lower limbs, cyanosis and local ischaemia. Doppler ultrasound revealed bilateral and proximal deep vein thrombosis (sural and superficial femoral veins of the right leg; sural and iliac veins of the left leg) without any distal arterial flow. We concluded on a diagnosis of bilateral phlegmasia cerulea dolens.
  
  
  CONCLUSIONS
  Phlegmasia cerulea dolens is a particular type of deep venous thrombosis in which a proximal venous thrombus is combined with arterial ischaemic signs due to brutal and massive oedema and slowing down of arterial flow. In most cases, the lower limbs are involved, with malignancy being the most common cause. It should be suspected in the presence of the classical triad of "pain, oedema and cyanosis", with confirmation by Doppler ultrasound. There is no general consensus regarding standard management. Traditionally, systemic anticoagulation has been the mainstay of treatment for this condition. Endovascular surgery may be a possibility in some cases. Prompt diagnosis and rapid treatment initiation are paramount in order to improve the prognosis of this severe condition with ominous prospects.
authors.affiliation: Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Zeboulon
authors.affiliation: Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Amy de la Bretèque
authors.affiliation: Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Bilan
authors.affiliation: Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Sin
authors.affiliation: Laboratoire d'explorations vasculaires, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Linder
authors.affiliation: Service de chirurgie thoracique et vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Dakhil
authors.affiliation: Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
authors.forename: M-L
authors.initials: ML
authors.lastname: Sigal
authors.affiliation: Service de dermatologie et médecine vasculaire, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France. Electronic address: emmanuel.mahe@ch-argenteuil.fr.
authors.forename: E
authors.initials: E
authors.lastname: Mahé
mesh_terms: D000368:Aged; D001167:Arteritis / Q000000981:diagnostic imaging*; D002277:Carcinoma / Q000556:secondary / Q000601:surgery; D003937:Diagnosis, Differential; D004487:Edema / Q000175:diagnosis; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D007511:Ischemia / Q000000981:diagnostic imaging*; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000175:diagnosis; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D013924:Thrombophlebitis / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D019459:Urothelium / Q000473:pathology; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*
keywords: Arterial thrombosis; Leg ulcers; Paraneoplastic syndromes; Phlegmasia cerulea dolens; Phlébite bleue; Syndrome paranéoplasique; Thrombose artérielle; Thrombose veineuse; Ulcère des membres inférieurs; Venous thrombosis