# When Educational Images Don’t Reflect the Population: Phlegmasia Cerulea Dolens, a Case Report

## TL;DR

This paper highlights how medical images and descriptions of PCD often reflect lighter skin tones, potentially leading to missed diagnoses in patients with darker skin.

## Contribution

The paper presents a rare case of PCD in a patient with darker skin and emphasizes the need for inclusive diagnostic criteria.

## Key findings

- Only two of 60 PCD case reports included images of patients of color.
- Diagnostic criteria for PCD are often based on findings in lighter-skinned patients.
- Accurate diagnosis requires awareness of phenotypic variations in clinical presentation.

## Abstract

Phlegmasia cerulea dolens (PCD) is an uncommon, potentially life-threatening complication of acute deep venous thromboses that requires a timely diagnosis. The name of the condition, the visual diagnostic criteria, and the preponderance of cases in the literature referencing findings exclusively in patients with lighter skin complexions means that PCD may not be on the differential diagnosis for the patient with more melanated skin who is experiencing this time-sensitive vascular emergency.

We describe one case of PCD in a patient with darker skin complexion and the importance of identifying clinical findings, regardless of skin color, given the paucity of reference images for PCD in darker complected patients. Our literature review yielded 60 case reports for PCD. Only two papers included images referencing patients of color.

Accurate diagnosis requires recognition of diagnostic findings, which may vary significantly between phenotypically distinct populations. Many pathognomonic physical exam findings rely on descriptors based on presentation in phenotypically white patients.