Department of Emergency Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, United States of America.
Hope College, 141 E. 12(th) St., Holland, MI 49423, United States of America.
Am J Emerg Med. 2022 Nov;61:234.e1-234.e3. doi: 10.1016/j.ajem.2022.08.009. Epub 2022 Aug 8.
Phlegmasia cerulea dolens (PCD) is a rare condition characterized by a severely swollen, cyanotic, blue extremity due to a large proximal (iliofemoral) deep venous thrombosis extending into the collateral veins. Mortality in PCD ranges 20-40%. Due to severely compromised venous drainage, compartment pressures can rapidly increase 16-fold within 6 h, but rarely result in arterial compromise.
We present a case of a middle-aged woman with no prior history of deep venous thrombosis, with a blue swollen left leg in intractable severe pain unresponsive to 3 doses of hydromorphone. Her pain was successfully alleviated with IV Lidocaine. Patient was found to have phlegmasia cerulea dolens resulting in compartment syndrome of her left leg. Although the patient initially had no motor function, after catheter-directed thrombolysis and emergent thrombectomy, she regained her motor function and made a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Phlegmasia cerulea dolens complicated by severe compartment syndrome is a rare entity. Prompt recognition and treatment are necessary to prevent irreversible limb ischemia and associated morbidity and mortality. IV Lidocaine may be considered as an option for analgesia for such patients.
苍蓝痛（PCD）是一种罕见的病症，其特征是由于近端（髂股）深静脉血栓延伸至侧支静脉而导致严重肿胀、发绀、蓝色的肢体。PCD 的死亡率为 20-40%。由于静脉引流严重受损，间隔压在 6 小时内可能迅速增加 16 倍，但很少导致动脉受损。
我们报告了一例中年女性，无深静脉血栓形成的既往史，左腿严重肿胀、发绀、剧痛，对 3 剂氢吗啡酮无反应。静脉注射利多卡因成功缓解了她的疼痛。患者被诊断为苍蓝痛，导致左腿间隔综合征。尽管患者最初没有运动功能，但在导管定向溶栓和紧急血栓切除术之后，她恢复了运动功能并完全康复。
为什么急诊医生应该了解这个问题？：苍蓝痛并发严重间隔综合征是一种罕见的疾病。及时识别和治疗对于预防不可逆的肢体缺血和相关发病率和死亡率至关重要。对于此类患者，静脉注射利多卡因可能被视为一种选择。
