Ultrasound-based multimodal diagnosis and endovascular therapy for phlegmasia cerulea dolens secondary to May-Thurner syndrome in a middle-aged male patient: A case report.
Weiwei Jiang, Ying Zhang
✦ AI-curated · Sources linked
Case in brief
A 54-year-old man presented with phlegmasia cerulea dolens associated with extensive left lower-limb deep vein thrombosis and iliac vein compression syndrome. Ultrasound rapidly identified thrombus in the femoral, popliteal, and calf intermuscular veins and characterized its extent, but did not show the iliac stenosis. CT angiography and venography confirmed the underlying compression. Emergency endovascular treatment—thrombus aspiration, catheter-directed thrombolysis, and iliac vein stenting—with perioperative anticoagulation restored limb blood flow; subsequent ultrasound assessed recanalization, and his edema and pain improved.
What made this case unusual
The case highlights a diagnostic limitation: ultrasound demonstrated extensive lower-limb thrombosis but could not directly visualize the causative iliac vein stenosis, which was confirmed with CT angiography and venography.
Diagnostic / clinical pearl
In suspected phlegmasia cerulea dolens, ultrasound can rapidly define lower-limb thrombus burden and monitor recanalization, but a negative or incomplete iliac assessment does not exclude iliac vein compression; use CT angiography and venography to confirm the cause when suspected.