Severe pain with cyanosis of limb, sudden complete venous occlusion of the entire limb outflow, venous gangrene may occur with a 50% amputation rate
Phlegmasia alba and cerulea dolens are rare manifestations of acute deep venous thromboses. Phlegmasia alba dolens (upper image), which translates to “painful white inflammation,” occurs when venous thrombosis progresses to a massive occlusion of the major deep venous system of the leg, but without ischaemia as collateral veins are still patent. The pallor is due to arterial spasm. Phlegmasia cerulea dolens translates to “painful blue inflammation” and is the next progression of the disease, characterised by complete thrombosis of the deep venous system, including the collateral circulation. This results in significant venous congestion, fluid sequestration, and worsening oedema.