Tuberc Respir Dis.  2008 Sep;65(3):225-229.

A Case of Phlegmasia Cerulea Dolens as a Complication Caused by Placement of Inferior Vena Cava Filter

• Cho YS
• Kim JH
• Lee HS
• Choi JS
• Na JO
• Seo KH
• Kim YH

Abstract

Inferior vena cava filters are increasingly being used as an alternative to anticoagulation therapy for the prevention of pulmonary embolism. However, using an Inferior vena cava filter may result in clinically significant complications. Phlegmasia cerulea dolens is a rare disease that presents with acute complete venous occlusion due to extensive thrombosis in the lower extremity. It is characterized by intense pain, edema, decreased pulses and a cyanotic extremity. We report here on a case of phlegmasia cerulea dolens that was accompanied with disseminated intravascular coagulation (DIC) as a complication of the placement of an inferior vena cava filter in a patient who had been previously diagnosed with pulmonary embolism, and the patient had recently developed a cerebral hemorrhage due to a traffic accident.

Keyword

Phlegmasia cerulea dolens; Inferior vena cava filter; Pulmonary embolism

MeSH Terms

Accidents, Traffic
Cerebral Hemorrhage
Disseminated Intravascular Coagulation
Edema
Extremities
Humans
Lower Extremity
Pulmonary Embolism
Rare Diseases
Thrombosis
Vena Cava Filters
Vena Cava, Inferior

Figure

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  Figure 1 Initial simple chest radiography shows cardiomegaly.

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  Figure 2 Precontrast brain computed tomography shows multiple contusional hemorrhage in both frontal and left temporal lobe.

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  Figure 3 Contrast pulmonary embolism computed tomography shows filling defect at the left inferior lobar pulmonary arteries.

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  Figure 4 A venacavogram shows an IVC filter in the infrarenal inferior vena cava.

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  Figure 5 Color doppler scan reveals an absence of flow at the vena caval filter insertion site.

Reference

1. Stein PD, Kayali F, Olson RE. Twenty-one-year trends in the use of inferior vena cava filters. Arch Intern Med. 2004. 164:1541–1545.

2. Joels CS, Sing RF, Heniford BT. Complications of inferior vena cava filters. Am Surg. 2003. 69:654–659.

3. Aruny JE, Kandarpa K. Phlegmasia cerulea dolens, a complication after placement of a bird's nest vena cava filter. AJR Am J Roentgenol. 1990. 154:1105–1106.

4. Feinman LJ, Meltzer AJ. Phlegmasia cerulea dolens as a complicati on of percutaneous insertion of a vena caval filter. J Am Osteopath Assoc. 1989. 89:63–68.

5. Martin JG, Marsh JL, Kresowik T. Phlegmasia cerulea dolens: a complication of use of a filter in the vena cava. J Bone Joint Surg Am. 1995. 77:452–454.

6. Patel SH, Patel R. Inferior vena cava filters for recurrent thrombosis: current evidence. Tex Heart Inst J. 2007. 34:187–194.

7. Büller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004. 126:401S–428S.

8. Greenfield LJ, McCurdy JR, Brown PP, Elkins RC. A new intracaval filter permitting continued flow and resolution of emboli. Surgery. 1973. 73:599–606.

9. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med. 1998. 338:409–415.

10. Gregorie R. Phlegmasia caerulea dolens. Presse Med. 1938. 46:1313–1315.

11. Bertelsen S, Anker N. Phlegmasia coerulea dolens: pathophysiology, clinical features, treatment, and prognosis. Acta Chir Scand. 1968. 134:107–114.

12. Yan BP, Kiernan TJ, Gupta V, Ajani AE, Schainfeld RM. Combined pharmacomechanical thrombectomy for acute inferior vena cava filter thrombosis. Cardiovasc Revasc Med. 2008. 9:36–40.

13. Comerota A, Aldridge SC. Thrombolytic therapy for deep venous thrombosis: a clinical review. Can J Surg. 1993. 36:359–364.

14. Schweizer J, Kirch W, Koch R, Elix H, Hellner G, Forkmann L, et al. Short and long term results after thrombolytic treatment of deep venous thrombosis. J Am Coll Cardiol. 2000. 36:1336–1343.