Snapshot quiz 11/13

Published: 06/07/2012

Authors: Peter M, Aldouri A, Haq A and Aldoori M

Phelgmasia cerulea dolens (PCD) is caused by thrombosis of deep and collateral veins, often resulting in gangrene from the venous congestion. These patients often present with a triad of severe pain, cyanosis and oedema. Cyanosis progressing proximally is often a pathognomonic finding in PCD. Initial management is anticoagulation with high elevation of the leg. If the foot remains at risk, thrombolysis with tPA using both arterial and venous routes of administration is often tried. Despite this, PCD often has a poor outcome and carries a high mortality (20–40 per cent), due to the frequent association with advanced malignancy.