Which physical findings of discoloration of the lower extremity suggest venous thrombosis?

Updated: Jun 06, 2019
  • Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Patients with venous thrombosis may have variable discoloration of the lower extremity. The most common abnormal hue is reddish purple from venous engorgement and obstruction. In rare cases, the leg is cyanotic from massive ileofemoral venous obstruction. This ischemic form of venous occlusion was originally described as phlegmasia cerulea dolens (“painful blue inflammation”). The leg is usually markedly edematous, painful, and cyanotic. Petechiae are often present.

In relatively rare instances, acute extensive (lower leg–to-iliac) occlusion of venous outflow may create a blanched appearance of the leg because of edema. The clinical triad of pain, edema, and blanched appearance is termed phlegmasia alba dolens (“painful white inflammation”), a term originally used to describe massive ileofemoral venous thrombosis and associated arterial spasm. This is also known as milk-leg syndrome when it is associated with compression of the iliac vein by the gravid uterus. The affected extremity is often pale with poor or even absent distal pulses. The physical findings may suggest acute arterial occlusion, but the presence of swelling, petechiae, and distended superficial veins point to this condition. As many as half the patients with phlegmasia alba dolens have capillary involvement, which poses a risk of irreversible venous gangrene with massive fluid sequestration. In severely affectedpatients, immediate therapyisnecessarytoprevent limb loss.


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