Differential Diagnosis

A differential diagnosis can now be made. Common differential diagnoses include:

Cerebrovascular accident (CVA)

Although the limb may be pale, cool and paralysed it should not be painful and Doppler signals should be audible.

Deep vein thrombosis (DVT)

The leg is usually warm, pink, swollen and tender. In phlegmasia cerulea dolens a DVT can cause venous gangrene. The foot usually appears blue, purple or black; arterial Doppler signals should be audible. Phlegmasia cerulean dolens should also be referred to a vascular specialist.

The image shows phlegmasia cerulea dolens.

Hypovolaemic shock

Hypovolaemic shock can present with pulseless limbs, but an accurate history and examination (hypotension, all limbs affected) should clarify the diagnosis.

Acute compressive neuropathy

Acute compressive neuropathy can present with a paralysed limb. Doppler signals should be normal.

Learning bite

Arterial Doppler examination and an accurate history should differentiate acute limb ischaemia from other common differential diagnoses.