Bilateral Phlegmasia Dolens Associated With Trousseau's Syndrome: A Case Report  Satoshi Hasegawa, PT, Tomoki Aoyama, D, PhD, Ryosuke Kakinoki, MD, PhD, Junya Toguchida, MD, PhD, Takashi Nakamura, MD, PhD  Archives of Physical Medicine and Rehabilitation  Volume 89, Issue 6, Pages 1187-1190 (June 2008) DOI: 10.1016/j.apmr.2007.10.030 Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 (A) Doppler ultrasound scan of both calves after administration. Bilateral peroneal veins were occluded by massive thromboses (arrowhead). The thrombosis was larger in the right (left panel) was than left peroneal vein (right panel). (B) A CT scan of both lower limbs. (a) One month before the onset of phlegmasia dolens. The ultrasound scan detected thromboses in the peroneal vein but not anomalous venous drainage. (b) The onset of phlegmasia dolens. The patient felt severe pain, but the diameter of both legs was unchanged. (c) Five days after the onset of phlegmasia dolens. The diameter of both legs was enlarged. The posterior compartment was especially swollen. The density of the soleus muscle was lowered. Edematous change of subcutaneous and intramuscular tissue is detected. (d) One month after the onset of phlegmasia dolens. The diameter and edema remain unchanged. The necrotic area of the soleus muscles showed cystic change (arrow). (e) Four months after the onset of phlegmasia dolens. The size of both legs is reduced. The necrotic area of the soleus muscle remains (arrow). (f) Eight months after the onset of phlegmasia dolens. The necrotic area is reduced, and compensated muscles are enlarged. Archives of Physical Medicine and Rehabilitation 2008 89, 1187-1190DOI: (10.1016/j.apmr.2007.10.030) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 The therapeutic process in the current case. The upper panel shows the change of APTT and FDP D-dimer. The middle panel shows the schedule for the anticoagulant therapy and rehabilitation program. The lower panel shows the functional evaluation. Range of ankle dorsiflexion of the joint (upper subpanel) and total FIM score (lower subpanel). Abbreviations: PD, phlegmasia dolens; ROM, range of motion. Archives of Physical Medicine and Rehabilitation 2008 89, 1187-1190DOI: (10.1016/j.apmr.2007.10.030) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions