Blues clues

A 70-year-old female with recently diagnosed extramedullary acute myeloid leukemia (AML) presented with severe shortness of breath and chest pain found to have a massive pulmonary embolism. On physical examination, the patient had acute phlegmasia cerulea dolens (painful blue edema) of her left lower extremity (Figures 1 and 2) secondary to extensive bilateral deep vein thrombosis (DVT) up to the proximal common iliac veins. Occlusive deep vein thrombosis of right common femoral vein (Figure 3) and that of left external iliac vein (Figure 4) are visible on Doppler ultrasound.