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February 1964

Massive Venous Thrombosis With Pulmonary Embolism

Arch Intern Med. 1964;113(2):208-212. doi:10.1001/archinte.1964.00280080044009

The clinical features of massive venous thrombosis, or phlegmasia cerulea dolens, have been well documented in the last 15 years. The onset is usually sudden and may or may not follow the commoner mild form of thrombophlebitis. The affected limb, usually a leg, becomes grossly swollen and cyanotic, often with cutaneous hemorrhages and bullae. Arterial pulsations are reduced, the superficial veins are distended, and shock is a common complication. Gangrene of part of the limb develops in 50% of cases, and the over-all mortality is about 25%.6

It is generally agreed that this picture appears only when almost the whole venous drainage of the limb is obstructed, although venospasm may contribute to the obstruction in some cases.7,8 Experimentally, gangrene has only been produced by blocking nearly all the veins draining the part.4,9,10 There is commonly malignant disease or inflammation in the pelvis, and some cases have followed