Phlegmasia cerulea dolens (PCD) is the term describing the painful venous c
ongestion that results from near-total venous occlusion of a limb. It is un
usual in the lower extremity but is decidedly rare in the upper extremity w
ith only a handful of cases reported in the literature. PCD of the upper ex
tremity usually occurs in patients with significant comorbid conditions suc
h as severe cardiac failure or advanced malignancy. PCD of the upper extrem
ity is associated with substantial morbidity and mortality. We present a ca
se of upper extremity PCD in an elderly man with a complex medical history,
complicated clinical course, and poor outcome that is typical for this rar
e disease.