Phlegmasia cerulea dolens presenting with acute compartment syndrome and pulmonary embolism

Description 

A 50-year-old woman, a known diabetic and hypertensive with poor compliance to treatment, presented with fever, dyspnoea and left-sided pleuritic chest pain for 15 days and left lower limb swelling worsening over the past 1 week. On examination, her vitals were stable, and she had significant left lower limb oedema extending up to the upper thigh with livedo reticularis (figure 1). The left lower limb pulses were not palpable. There was excruciating pain on light touch and passive flexion of the toes and ankle. Urgent arterial and venous Doppler sonography of the lower limbs revealed a left-sided iliofemoral venous thrombus. With the clinical diagnosis of acute compartment syndrome, urgent single incision four compartment fasciotomy was performed.

Figure 1

(A) Clinical examination at the time of admission showing lower limb oedema with livedo reticularis, (B) left lower leg livedo reticularis with superficial blistering (white arrow) and (C)...

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