Phlegmasia Cerulea Dolens.

Massive DVT that obliterates the major deep venous channel of the extremity with relative sparing of collateral veins causes a condition called phlegmasia alba dolens.

This condition is characterized by pain, pitting edema, and blanching.

There is no associated cyanosis.

When the thrombosis extends to the collateral veins, massive fluid sequestration and more significant edema ensues, resulting in a condition known as phlegmasia cerulea dolens.

Phlegmasia cerulea dolens is preceded by phlegmasia alba dolens in 50 to 60% of patients.

The affected extremity in phlegmasia cerulea dolens is extremely painful, edematous, and cyanotic, and arterial insufficiency or compartment syndrome may be present.

If the condition is left untreated, venous gangrene can ensue, leading to amputation.