RT Book, Section A1 Tsekouras, Nikos A1 Comerota, Anthony J. A2 Dean, Steven M. A2 Satiani, Bhagwan A2 Abraham, William T. SR Print(0) ID 1105291496 T1 PHLEGMASIA CERULEA DOLENS T2 Color Atlas and Synopsis of Vascular Diseases YR 2015 FD 2015 PB McGraw-Hill Medical PP New York, NY SN 9780071749541 LK accesscardiology.mhmedical.com/content.aspx?aid=1105291496 RD 2024/10/10 AB A 65-year-old gentleman was referred with left lower extremity phlegmasia cerulea dolens (PCD) 1 day following an exploratory laparotomy. Postoperatively he developed painful diffuse swelling of his left lower extremity with bluish discoloration (Figure 58-1). On arrival, he underwent a venous duplex that demonstrated thrombosis of his tibial, popliteal, femoral, common femoral, and external iliac veins. Computed tomographic angiography (CTA) scan with contrast of the head, chest, abdomen, and pelvis was performed. The patient had bilateral, asymptomatic pulmonary emboli (Figure 58-2), and mediastinal, retroperitoneal, and pelvic lymphadenopathy (Figure 58-3), which subsequently proved to be lymphoma. The patient was brought to the interventional radiology suite and an ascending phlebogram was performed. The phlebogram confirmed extensive venous thrombosis from the calf veins through the iliac veins (Figure 58-4). With the patient in the supine position and under ultrasound guidance, access to the posterior tibial vein was obtained through which an EKOS Lysus (EKOS Corp, Bothell, WA) catheter was positioned. The patient was then placed in the prone position. Under ultrasound guidance, the popliteal vein was entered and a sheath advanced through which a Trellis (Covidien, Mansfield, MA) catheter was used (Figure 58-5).