Phlegmasia alba dolens describes the initial stage in the presentation of deep iliac vein thrombosis with partial impairment of arterial flow resulting in edema and "milky" appearance of the involved limb. Predisposing conditions consist of malignancy, hypercoagulability, ulcerative colitis, heart failure, mitral valve stenosis, pregnancy, oral contraceptive use, surgery, immobilization and antiphospholipid syndrome.
Phlegmasia alba dolens is usually seen in the lower extremities, especially in the left leg and consists of edema, pain and white color of the skin (caused by venous stasis, as a consequence of femoral vein thrombosis, thus the term "alba"), because cyanosis has not occurred yet, as phlegmasia alba precedes phlegmasia cerulea and arterial compromise is not as severe. The white color of the skin is caused by edema, not vasospasm, as initially postulated. Symptoms occur abruptly or gradually and progress to weakness, paresthesia, skin lesions like bullae and compartment syndrome, as collateral vessels become affected. The end stage is represented by venous gangrene and shock  . Arterial pulses in the affected limb are weak or absent at this stage.
When facing phlegmasia alba dolens patients, the physician should search for and eliminate all the triggering factors highlighted above, keeping in mind that in one tenth of cases a predisposing factor cannot be found. Since malignancy is found in 20-40% of patients, this kind of pathology should be carefully looked for .
Clinical examination should differentiate this condition from symmetric peripheral gangrene, characterized by a patent arterial bed, occlusion of venules and capillaries  and disseminated intravascular coagulation. However, this disease also involves tegument area not belonging to limbs, making clinical differential diagnosis easier.
If the diagnosis is not established in this stage, the clinical status deteriorates due to progression to complications like pulmonary embolism and venous gangrene, potentially life- threatening conditions  .
Entire Body System
Vietnamese - English Vietnamese - Vietnamese Vietnamese - French French - Vietnamese Computing English - English Chinese - Vietnamese Search in: Word Vietnamese keyboard: Off Virtual keyboard: Show English - English (Wordnet) dictionary phlegmasia alba [vdict.com]
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180 millions of speakers Translator Portuguese - Japanese phlegmasia 130 millions of speakers Translator Portuguese - Korean phlegmasia 85 millions of speakers Translator Portuguese - Javanese phlegmasia 85 millions of speakers Translator Portuguese - Vietnamese [educalingo.com]
제15장 산욕합병증 (The abnormal puerperium & complication) ·puerperal pyrexia, p. fever;산욕열 분만후 자궁내막 감염후 열이나는 상태 "A febrile state caused by infection of the endometrium and Septicemia following delivery" ·미국여성 보건 협의회 : 산후 24시간을 제외한 10일 이내에 38。 [m.cafe.daum.net]
This process can result in massive fluid sequestration and the development of skin bullae and blebs.4 Further progression results in venous gangrene when muscle ischemia becomes infarction. [emra.org]
Cutaneous manifestations of internal malignant tumors. Arch Dermatol 1942; 45:1069-1080. Ganda OP, Weir GC, Soeldner JS, et al. Somatostatinoma: A somatostatin-containing tumor of the endocrine pancreas. N Engl J Med 1977; 296:963-967. [pathology.jhu.edu]
The dead subject presents a remarkable disfiguration of the countenance, tumefaction and discoloration of the external genitals, excoriation, ulcerative destruction of various characters, with or without laceration of the perineum, various vaginal discharges [chestofbooks.com]
In cases of pregnancy, it is most often seen during the third trimester, resulting from a compression of the left common iliac vein against the pelvic rim by the enlarged uterus. [en.wikipedia.org]
[Pulmonary thromboembolism after chronic bladder distention].Prog Urol. 2001; 11: 323-326 Kumar V. Marr C. Bhuvangiri A. Irwin P. [goldjournal.net]
The diagnosis of Phlegmasia alba and cerulea dolens is a clinical one, but imaging methods can help establish the presence of venous thrombosis.
The most widespread diagnosis method is ultrasonography, with duplex ultrasonography being more accurate, if available. Deep vein thrombosis is suggested by a dilated, non-compressible vein with no spontaneous blood flow and hyperechoic masses inside, represented by thrombi . Being a portable and noninvasive method, it tends to replace contrast venography, that still represents the gold standard for diagnosis in uncertain cases. Technical difficulties may be encountered when trying to perform a venography, as extensive thrombosis prevents proper visualization of the venous system; in this case, the venous system belonging to the affected leg can be approached via the contralateral femoral vein or via the upper extremity veins in order to obtain at least some information about the iliocaval system. In patients where the extent of the thrombosis cannot be properly evaluated, computer tomographic venography and magnetic resonance venography can be performed . These methods have a supplementary advantage, represented by the fact that they can describe associated venous abnormalities or pelvic pathological processes compressing the iliac veins.
- Hasegawa S, Aoyama T, Kakinoki R, et al. Bilateral phlegmasia dolens associated with Trousseau's syndrome: a case report. Arch Phys Med Rehabil. 2008;89(6):1187-1190.
- Bhardwaj R, Kandoria A, Sharma RK, et al. A case of venous gangrene, treated successfully with thrombolytic therapy and skin grafting. J Assoc Physicians India 2008;56:640-642.
- Chinsakchai K, Ten Duis K, Moll FL, et al. Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg. 2011; 45(1):5-14.
- Warkentin TE. Ischemic Limb Gangrene with Pulses. N Engl J Med. 2015;373(7):642-655.
- Suwanabol PA, Tefera G, Schwarze ML. Syndromes associated with the deep veins: phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome. Perspect Vasc Surg Endovasc Ther 2010;22(4):223-230.
- Fraser JD, Anderson DR. Deep venous thrombosis: recent advances and optimal investigation with US. Radiology 1999;211(1):9-24.