From Negative Duplex to Phlegmasia in Minutes: Bedside POCUS Identifies Rapid Thrombosis Unmasking Underlying May-Thurner Syndrome.
Anthony Unger
✦ AI-curated · Sources linked
Case in brief
A 50-year-old female presented with left leg swelling after hospitalization for ulcerative colitis. Initial duplex ultrasound was negative for DVT, but a subsequent point-of-care ultrasound (POCUS) revealed a rapidly evolving thrombus just 14 minutes later. This led to the diagnosis of phlegmasia cerulea dolens and underlying May-Thurner syndrome, requiring urgent surgical intervention. The patient made a complete recovery.
What made this case unusual
The case illustrates the rapid progression from a negative duplex ultrasound to phlegmasia cerulea dolens, highlighting the critical role of POCUS in identifying acute changes in vascular status.
Diagnostic / clinical pearl
Clinicians should consider the potential for rapid thrombus formation in patients with risk factors, even when initial imaging is negative.
Why it matters
This case underscores the importance of bedside ultrasound in emergency settings, particularly for detecting evolving vascular emergencies that may not be evident on standard imaging.