Phlegmasia Cerulea Dolens Related to Urinary Retention

Published:November 22, 2020DOI:
      A 78-year-old man with benign prostatic hyperplasia and advanced dementia presented to the hospital with 1 day of increasing confusion. He could not report symptoms, but caregivers at his nursing home noted that he was restless and less attentive and brought him to the emergency department. Upon transfer to the hospital stretcher, he was found to have marked purple-blue discoloration of his left leg (Figure 1). His vital signs showed him to be afebrile with an elevated heart rate at 100 beats per minute, blood pressure 128/91 mm Hg, and oxygen saturation of 97% on room air. He was awake, appeared uncomfortable, but was unable to answer questions because of his underlying dementia. His left leg was discolored but warm with normal pedal pulses. His lower abdomen was distended and tender to palpation in the suprapubic region. Bedside ultrasound showed marked bladder distension, and a urinary catheter was placed which drained a total of 1700 mL of clear urine. Within several minutes of bladder decompression, the patient's leg discoloration had completely resolved (Figure 2). Subsequent lower extremity ultrasonography and computed tomography of the pelvis did not reveal any deep venous thrombosis, arterial insufficiency, or vascular anomalies.
      Figure 1
      Figure 1Upon arrival, the patient's left leg was found to have marked purple-blue discoloration (pre-Foley).
      Figure 2
      Figure 2Within several minutes of bladder decompression, the patient's leg discoloration had completely resolved (post-Foley).
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