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 [1] [2]. 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 [3].

Clinical examination should differentiate this condition from symmetric peripheral gangrene, characterized by a patent arterial bed, occlusion of venules and capillaries [4] 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 [5] [6].

• Pain

  Suggestions See the help to know how search results can be improved Ask in our forum Send us email Definitions and Meaning of phlegmasia alba dolens in English noun painful thrombosis of the femoral vein in the leg following childbirth English to hindi [shabdkosh.com]

  […] noun Medicine Pain, swelling, and pallor of a limb caused by acute deep venous thrombosis; especially that of a leg, most commonly seen in women after childbirth (also called milk leg, white leg). [en.oxforddictionaries.com]

  […] thrombophlebitis of the femoral vein, resulting in pain and edema of the leg. [medical-dictionary.thefreedictionary.com]

  Symptoms :- In this disease, first of all, pain starts from the ankle and then is moved to the upper section of the legs. Swelling and pain occur in the veins with the feeling of toughness and heaviness in them. [jkhealthworld.com]

• Swelling

  Lycopodium- One vein among two veins of the legs is called ‘Saphena vein’ that is swelled up after delivery, which is called ‘Phlegmasia Alba Dolens’. In this disease, swelling moves from lower to upper section of the legs. [jkhealthworld.com]

  “Most patients with iliofemoral DVT (IFDVT) present with swelling that involves the entire limb, causing varying degrees of discomfort. [emorysurgicalfocus.com]

  […] noun Medicine Pain, swelling, and pallor of a limb caused by acute deep venous thrombosis; especially that of a leg, most commonly seen in women after childbirth (also called milk leg, white leg). [en.oxforddictionaries.com]

  Venous blood clot : - Symptoms : - Pain, swelling, and bluish-skin coloring affect the area below the blocked vein. [indiahospitaltour.com]

  The condition may ... (26 of 153 words) www.britannica.com/EBchecked/topic/382525/milk-leg American Heritage Dictionary: milk leg A painful swelling of the leg occurring in women after childbirth as a result of clotting and inflammation of the femoral [memidex.com]

• Gangrene

  When venous gangrene occurs, it has a similar distribution with the cyanosis. [thehealthscience.com]

  The end stage is represented by venous gangrene and shock. Arterial pulses in the affected limb are weak or absent at this stage. [symptoma.com]

  Phlegmasia caerulea dolens and venous gangrene. Br J Surg. 2005;83(1):19-23. Haimovici H. The ischemic forms of venous thrombosis, Phlegmasia cerulea dolens, Venous gangrene. J Cardiovasc Surg (Torino). 1965 Sep-Oct;5(6):Suppl:164-73. [bcemergencynetwork.ca]

  This leads to acute ischemia and venous gangrene. [ncbi.nlm.nih.gov]

• Inflammation

  The condition may ... (26 of 153 words) www.britannica.com/EBchecked/topic/382525/milk-leg American Heritage Dictionary: milk leg A painful swelling of the leg occurring in women after childbirth as a result of clotting and inflammation of the femoral [memidex.com]

  […] alba dolens or “painful white inflammation.” [pubmed.ncbi.nlm.nih.gov]

  An inflammation; more particularly, an inflammation of the internal organs. [1913 Webster] {Phlegmasia dolens} (d[=o] l[e^]nz) [NL.], milk leg. [1913 Webster] … The Collaborative International Dictionary of English Phlegmasia — Phleg*ma si*a, n. [translate.enacademic.com]

  It either depends upon an inflammation of the veins of the inferior extremity, and especially of the crural vein, or upon an inflammation of the cellular tissue, which gives rise to the most various products. [chestofbooks.com]

• Chills

  ·예방 : 다리순환증진 * Signs and symtom : postdelivery 10-20 일 사이 ·fever, chills, malaise ·stiffness, pain, swelling in the affected leg 강직, 경직(swellen area : shiny white in color) 부었기 때문에 희고 반짝거린다. [m.cafe.daum.net]

  The fever commences with a violent chill, followed by heat, with a full, irritated, at first hard, and afterwards soft pulse. [chestofbooks.com]

  The symptoms of a peritonsillar abscess include: Severe sore throat that is worse on one side Fever and chills Swollen lymph glands Trouble swallowing Pain when you speak Call your doctor right away if you have trouble breathing, swallowing, talking, [familydoctor.org]

  Symptoms of peritonsillar abscess include: Fever and chills Severe throat pain that is usually on one side Ear pain on the side of the abscess Difficulty opening the mouth, and pain with opening the mouth Swallowing problems Drooling or inability to swallow [medlineplus.gov]

  […] symptoms start, such as: red, swollen tonsils tender, swollen glands (lymph nodes) on one side of the neck a tonsil that's pushing against the uvula severe pain on one side of the throat difficulty and pain when swallowing or opening the mouth fever and chills [kidshealth.org]

• Common Cold

  ``We are gratified the Commission has taken no action regarding the fundamental claim ... regarding the reduction in the duration and severity of the common cold -- a claim that has been established in a rigorous clinical environment.'' [dic.impact.pe.kr]

• Nausea

  […] was orally intubated for airway protection and was given a total of 4 L of normal saline intravenously (IV) for hypotension and acidosis; sodium bicarbonate for metabolic acidosis; norepinephrine for hypotension; fentanyl for pain; and ondansetron for nausea [mdedge.com]

  Constant nausea and vomiting every month, after menstruation. Cannot lie on right side, without vomiting dark-green matter. Black or coffee-grounds vomiting. Cancer of stomach with vomiting of bloody, slimy mucus. [homeoint.org]

  Other accompanying features include fever with rigors and chills, malaise, body aches, headache, nausea, and constipation. [ncbi.nlm.nih.gov]

  Other general symptoms include episodic sweating, tremor and rapid heart rate, as well as hunger, nausea, weight gain, and sometimes even central nervous system symptoms (including rarely, seizures). Gastrinomas over-secrete the hormone gastrin. [pancreatica.org]

• Thrombosis

  Suggestions See the help to know how search results can be improved Ask in our forum Send us email Definitions and Meaning of phlegmasia alba dolens in English noun painful thrombosis of the femoral vein in the leg following childbirth English to hindi [shabdkosh.com]

  The diagnosis of Phlegmasia alba and cerulea dolens is a clinical one, but imaging methods can help establish the presence of venous thrombosis. [symptoma.com]

  In 1938, Gregoire made an outstanding description of the condition and used the term PCD to differentiate ischemia-associated massive venous thrombosis from phlegmasia alba dolens, which describes fulminant venous thrombosis without ischemia. [1] The [thehealthscience.com]

  Tanaka et al. reported that IL-6 could activate the coagulation cascade [6], increasing the risk of thrombosis and complication. [emorysurgicalfocus.com]

• Cyanosis

  Look for the “milk leg triad” of Phlegmasia Alba Dolens: pain, swelling, and blanching of skin without cyanosis. In Phlegmasia Cerulea Dolens cyanosis happens. Worsening edema and cyanotic skin changes, such as bullae and necrosis, start appearing. [bcemergencynetwork.ca]

  Cyanosis is the pathognomonic finding of PCD, progressing from distal to proximal areas. When venous gangrene occurs, it has a similar distribution with the cyanosis. [thehealthscience.com]

  Phlegmasia alba dolens presents as a triad of edema, pain, and white blanching skin without cyanosis. [emra.org]

  However, the venous return is efficient enough to clear the dermal and subdermal venous blood before cyanosis occurs. [emorysurgicalfocus.com]

• Vascular Disease

  (Contributor) Surgery Faculty of Medicine and Pharmacy Clinical sciences Surgical clinical sciences Cardio-vascular diseases Vascular surgery Diabetes Clinic Activity: Talk or presentation › Talk or presentation at a workshop/seminar Period 28 Jan 2022 [researchportal.vub.be]

  In addition, this book provides a basic knowledge of the pathophysiology of vascular disease, interventional techniques, and endovascular modalities of various disease categories. [books.google.ro]

  Mohler III, MD Demos Medical Publishing, ١٦‏/١٢‏/٢٠١١ - 208 من الصفحات Atlas of Vascular Medicine provides concise overviews of current management of vascular diseases utilizing a case-based format. [books.google.com]

  Abstract Acute thrombosis of the lower limb deep veins remains one of the most common vascular diseases. It is characterised by formation of thrombotic masses in the system of the deep veins of the lower extremities. [ncbi.nlm.nih.gov]

• Ulcer

  ULCERS OF THE STOMACH AND DUODENUM CON SECUTIVE TO APPENDICITIS 709 713 TRANSFORMATION OF SIMPLE ULCER OF THE STOMACH INTO CANCER 717 724 734 738 740 746 748 750 750 SIMPLE ULCER OF THE DUODENUMPERFORATION SUPERAOUTE 832 INTESTINAL OCCLUSION 838 DYSENTERY [books.google.com]

  This process is associated with excruciating pain, swelling, ulceration, and development of wet gangrene. It is also referred to as "milk leg" because of the whitish discoloration secondary to venous outflow obstruction. [wikidoc.org]

  At least 20% of patients with venous disease will develop leg ulcers. [de.slideshare.net]

  Predisposing conditions consist of malignancy, hypercoagulability, ulcerative colitis, heart failure, mitral valve stenosis, pregnancy, oral contraceptive use, surgery, immobilization and antiphospholipid syndrome. [symptoma.com]

• Blister

  This patient, aged more than 90 years, with a history of atrial fibrillation presented with atypical measles syndrome and sudden changes to both feet, which are cold to touch, with no pulses palpable or by Doppler and blisters that are getting larger [clinicaladvisor.com]

  A person is sometimes able to see the abscess toward the back of the throat, and it may look like a blister or a boil. [medicalnewstoday.com]

  This can cause massive fluid loss and fluid-filled skin blisters. How Is Phlegmasia Cerulea Dolens Diagnosed? To diagnose PCD, a doctor will ask you about your symptoms. [webmd.com]

  It looks like a swollen, whitish blister or boil. [healthline.com]

• Erythema

  Unilateral left leg swelling and erythema (A) and phlegmasia cerulea dolens (B) as shown by severe edema, weeping ulcers, and dusky blue appearance distally Morales MH, Leigh CL, Simon EL. [emorysurgicalfocus.com]

  References:[2][4][5] Clinical features May be asymptomatic Localized unilateral symptoms Typically affects deep veins of the legs, thighs, or pelvis Swelling, feeling of tightness or heaviness Warmth, erythema, and possibly livid discoloration Progressive [amboss.com]

  […] potato" voice (speaking as if a hot object was in the mouth), a toxic appearance (eg, poor or absent eye contact, failure to recognize parents, irritability, inability to be consoled or distracted, fever, anxiety), drooling, severe halitosis, tonsillar erythema [merckmanuals.com]

  […] 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, tympanitic distension of the abdomen, a livid erythema [chestofbooks.com]

  […] sore throat on the affected side Odynophagia (pain during swallowing) Fever Malaise Headache Hot potato voice (distortion of vowels) Referred ear pain Tender swollen jugulodiagastric lymph nodes Foul breath Uvula may be displaced to the unaffected side Erythema [lecturio.com]

• Excoriation

  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]

• Ankle Pain

  Some issues caused by flat feet include: Inflammation of soft tissue Foot, arch, and leg fatigue Heel, foot, and ankle pain Knee, hip, and lower back pain Rolled-in ankles Abnormal walking patterns Shin splints Bunions Hammertoe Arthritis Plantar fasciitis [afacc.net]

  Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker Related Injuries General Information Heel Pain Ankle Pain Foot Pain Heel Pain Heel Spur Traumatic Ankle Ligament Injuries Sprained Ankle High Ankle Sprain Tendinopathies/Fasciopathies Achilles [physioworks.com.au]

  […] complications: Midfoot arthritis (strain of medial midfoot, compression of lateral midfoot) Sprain of spring/deltoid ligaments 1st MTPJ Valgus deformity (bunion) Medial ankle pain Sinus tarsi pain Shortening of gastrocnemius Knee valgus deformity Tibial [now.aapmr.org]

  The foot may become painful. The child may begin to complain of foot and ankle pain after a minor twisting injury and the pain not resolve after a normal healing period. [eorthopod.com]

• Epistaxis

  Epistaxis, blood black and stringy, ozæna, after exanthemata or syphilis. Face.-- Acne. Lips swollen and numb. Leaden-colored and yellow face. Lockjaw. Mouth.-- Tongue red and small, but feels swollen. [homeoint.org]

• Seizure

  PE Signs and Symptoms Patients with pulmonary embolism may present with atypical symptoms, such as the following:  Seizures  Syncope  Abdominal pain  Fever  Productive cough  Wheezing  Decreasing level of consciousness  New onset of atrial fibrillation [slideshare.net]

  Other general symptoms include episodic sweating, tremor and rapid heart rate, as well as hunger, nausea, weight gain, and sometimes even central nervous system symptoms (including rarely, seizures). Gastrinomas over-secrete the hormone gastrin. [pancreatica.org]

  Symptoms include confusion, seizure, obtundation, personality change and coma, as well as palpitations, tremulousness, diaphoresis (sweating) and tachycardia (fast heart rate). [pathology.jhu.edu]

• Vaginal Discharge

  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]

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 [6]. 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 [5]. 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.

Recommended Treatment Treatment should not be delayed if suspected. The limb should be elevated to 60 degrees above level of the heart to encourage venous return and decrease edema. [bcemergencynetwork.ca]

Cerulea Dolens Treatment Hospital, India Phlegmasia Alba Dolens Treatment Hospital [indiasurgerytour.com]

Signs and tests : - For information on diagnosis, see: Deep venous thrombosis Treatment : - For information on treatment, see: Deep venous thrombosis Complications : - Continued clotting leads to increased swelling. [indiahospitaltour.com]

Treatment seems to depend on grading the severity of this condition and experience of the surgeon.” Comerota AJ. Kasper GC. (2019). Compartment Syndrome and Venous Gangrene. [emorysurgicalfocus.com]

Their prognosis and treatment strategy is debated. [enets.org]

Each disease entity is introduced by an illustrative case presentation and is followed by a detailed topic review including clinical features, laboratory and imaging workup, treatment and prognosis, clinical pearls, discussion of differential diagnoses [books.google.ro]

Therefore, proper diagnosis and early treatment is vital to having a good prognosis. [medicinenet.com]

Applicable To Deep vein thrombosis, postpartum Pelvic thrombophlebitis, postpartum Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

⑥ tender uterus with foul-smelling discharge 농성의 탁한 분비물 ⑦ dark or profuse lochia 악취오로 ·Treatment ① antibiotics ② ergonovine (promotes uterine tone) ③ fowler's position to promate drainage ④ hydration (3) pelvic cellulitis or parametritis (골반 봉와직염) ◆ Etiology [m.cafe.daum.net]

It reviews the epidemiology, pathophysiology, etiology, physical examination, imaging modalities, diagnosis, and treatment of limb ischemia. [books.google.it]

Diffuse left iliac vein stricture likely the etiology of the patient’s DVT and consistent with May–Thurner syndrome. Pt has signs of left leg ischemia. An immediate thrombectomy was performed with a stent placement. [shmabstracts.org]

Conference: 12th Annual ENETS Conference (2015) Category: Epidemiology/Natural history/Prognosis - Prognosis Presenting Author: Doctor Valbona Lico Authors: Milanetto A C, Lico V, Alaggio R, Martini C, ... [enets.org]

The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer. 1. [oalib.com]

He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. [litfl.com]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Epidemiology Frequency More than 600,000 cases of venous thromboembolism are estimated to occur annually in the United States. [thehealthscience.com]

The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer. 1. [oalib.com]

In addition, this book provides a basic knowledge of the pathophysiology of vascular disease, interventional techniques, and endovascular modalities of various disease categories. [books.google.ro]

References:[2][3] Pathophysiology The Virchow triad The Virchow triad refers to the three main pathophysiological components of thrombus formation. [amboss.com]

Pathophysiology In phlegmasia alba dolens, the thrombosis involves only major deep venous channels of the extremity, therefore sparing collateral veins. [thehealthscience.com]

The next step in the disease progression is occlusion of the superficial venous system, thereby preventing all venous outflow from the extremity. At this stage it is called phlegmasia cerulea dolens. [en.wikipedia.org]

The mainstays of treatment are to prevent the propagation of intravenous clotting and further stasis, reduce venous hypertension, avoidance of hypovolemic shock with fluid resuscitation, prevent progression to fulminant gangrene and preserve tissue viability [ncbi.nlm.nih.gov]

1. 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.
2. 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.
3. Chinsakchai K, Ten Duis K, Moll FL, et al. Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg. 2011; 45(1):5-14.
4. Warkentin TE. Ischemic Limb Gangrene with Pulses. N Engl J Med. 2015;373(7):642-655.
5. 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.
6. Fraser JD, Anderson DR. Deep venous thrombosis: recent advances and optimal investigation with US. Radiology 1999;211(1):9-24.