Snapshot quiz 16/2

Published: 03/02/2016

Authors: Zhou Z, Zhang D and Rahi A

Phlegmasia cerulea dolens. A 79-year-old man presented with sudden onset of right foot numbness. (a) On examination, the right leg was cold, swollen and cyanosed with no other sensory or motor loss. (b) CT angiography revealed no arterial occlusion, but thrombus in the distal inferior vena cava (blue arrow). The thrombus extended to the right common and external iliac veins. The diagnosis was phlegmasia cerulea dolens (painful blue swelling). The symptoms are caused by extensive deep venous thrombosis; co-existing malignancy is found in about 50 per cent of patients. This man had metastatic prostate cancer. He was treated with low molecular weight heparin but died shortly after admission.