Phlegmasia cerulea dolens is a serious condition and a result of central venous obstruction which can lead to venous gangrena and amputation of the affected limb. Multiple underlying conditions are described: malignant disease, trauma and hypercoagulable states such as heparin-induced thrombocytopenia, deficiency of protein C and antithrombin III. Phlegmasia cerulea dolens is also described as complication to insertion of a vena caval filter. We present a patient who developed phlegmasia cerulea dolens in his left lower limb as a result of an undiagnosed lumbal aortic aneurysm. To our knowledge this is the first report of phlegmasia cerulea dolens as the initial symptom of an abdominal aneurysm.