Resolution of Phlegmasia Cerulea Dolens in a Patient with Metastatic Cancer and an Inferior Vena Cava Filter.

Phlegmasia cerulea dolens (PCD) is a rare but serious complication of extensive venous thromboembolism (VTE) that can lead to limb ischemia and significant morbidity if not treated promptly. We describe a 69-year-old man with metastatic non-small cell lung cancer and hemorrhagic brain metastases who developed rapidly progressive PCD despite recent negative imaging and an existing inferior vena cava filter. He presented with bilateral lower extremity discoloration, absent Doppler signals, and signs of end-organ involvement. The patient underwent urgent mechanical thrombectomy with rapid clinical improvement and restoration of venous flow. This case highlights how quickly PCD can develop in high-risk patients and supports thrombectomy as a useful option for the resolution of extensive VTE and PCD.