An association between venous thromboembolism (VTE) and cancer has been recognized for over 100 years . Nevertheless, VTE remains under diagnosed under treated in patients with cancer . The relationship between the two is further supported by the observation that presentation with VTE may precede the development or diagnosis of cancer. Because patients presenting with idiopathic VTE frequently do not receive appropriate evaluation, any idiopathic VTE should elicit a very careful history and physical exam to ensure there is no underlying malignancy.
A 51 year‐old male with only a history of a remote perforated ulcer presented to the hospital with left lower extremity pain and swelling of 1 day duration that started on thigh and progressively involved calf and leg. In addition, review of systems revealed weight loss of 5‐10 lbs, anorexia and vague epigastric abdominal pain. He was diagnosed with left leg deep venous thrombosis (involving the common femoral vein to the level of the popliteal vein), started on appropriate anticoagulation and discharged.
Two months later, the patient presented again with abdominal pain, lower back pain and worsening pain involving his lower extremity as well. CT of Abdomen and pelvis was done which showed a large retroperitoneal mass near the aortic bifurcation measuring 3 x 5.5 x 7 cm along with retroperitoneal adenopathy. The tumor was encasing the distal abdominal aorta and inferior vena cava as well. Labs including CEA, CA 19‐9 and PSA were within normal limits. A CT guided biopsy was performed which showed undifferentiated small cell cancer. Further workup was unremarkable. The patient was finally diagnosed with small cell cancer of unknown primary and started the first cycle of chemotherapy.
In view of the well‐recognized risk of VTE in established cancer, it has been suggested that idiopathic VTE may predict the presence of occult cancer. Large prospective studies yield an incidence of previously undiagnosed cancer of 4%–5% in patients presenting with VTE [4‐5]. Other, smaller, studies have detected cancer in as many as 7%–12% of patients with idiopathic VTE, compared with only 2%–3% of patients with VTE associated with identifiable risk factors [3, 6, 7]. In two studies in which patients presenting with VTE underwent intensive investigation for cancer, the incidence of occult cancer was detected in up to 25% of patients [7, 8]. In view of these findings, it has been suggested that an underlying cancer should always be considered in patients presenting with VTE, especially if there is no identifiable risk factors.
In addition to age appropriate screening, a patient diagnosed with an idiopathic VTE needs a very thorough history and careful physical exam to ensure there is no underlying malignancy. Aside from the common cancers, we should ne reminded that the symptoms may indicate other uncommon malignancies that are not as easily detected.
To cite this abstract:Alwash H. Another Case of Simple Idiopathic Deep Vien Thrombosis. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 315. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/another-case-of-simple-idiopathic-deep-vien-thrombosis/. Accessed April 1, 2020.