SHM Converge Scientific Abstract ePoster Gallery-Trousseau's Syndrome Unmasked: A Cascade of Arterial and Venous Thrombosis Revealing Metastatic Adenocarcinoma

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This case describes a 71-year-old woman with hypertension and asthma who initially presented with a right-leg infection and was incidentally found to have a right lower-extremity DVT and bilateral pulmonary emboli. Her thrombosis was initially attributed to recently started estrogen therapy, and she was discharged on apixaban. Ten days later, she returned with flank pain, and CT imaging showed right renal infarcts and multiple hepatic hypodensities. Anticoagulation was changed to therapeutic enoxaparin, but within hours she developed acute confusion and aphasia.<br /><br />Further workup revealed multifocal acute infarcts on brain MRI involving both anterior and posterior circulations. TEE showed no intracardiac thrombus or PFO. MRI of the abdomen demonstrated numerous hepatic lesions, and liver biopsy confirmed poorly differentiated adenocarcinoma, favored to be cholangiocarcinoma. Tumor markers CA 19-9 and CA-125 were elevated, while the hypercoagulable evaluation was negative.<br /><br />The clinical picture was most consistent with Trousseau’s syndrome, a malignancy-associated hypercoagulable state that can cause recurrent arterial and venous thromboses, often before cancer is diagnosed. In this case, progression of thrombosis despite sequential therapeutic anticoagulation (DOAC then LMWH) and involvement of multiple vascular territories strongly suggested occult cancer-related thrombosis.<br /><br />The key message is that recurrent thrombosis across different vascular beds, especially when it worsens despite adequate anticoagulation, should prompt urgent evaluation for hidden malignancy. Heparin-based anticoagulation is generally preferred in cancer-associated thrombosis, and early recognition can accelerate diagnosis and multidisciplinary cancer care.

Asset Subtitle

Mansha Gupta

Meta Tag

Author List Hamza Khan, Kyle Williams, Mansha Gupta, Shrenil Kavathia

Category Clinical Vignettes

Concept Trousseau Syndrome

Concept Malignancy

Concept Hypercoagulable State

Concept Thrombotic Event

Concept Cancer-Associated Thrombosis

Distinguished Non-Finalist

Presenter Organization Midwestern University

Presenting Author Mansha Gupta

Track Adult

Keywords

Trousseau syndrome

malignancy-associated hypercoagulability

cholangiocarcinoma

deep vein thrombosis

pulmonary embolism

renal infarction

multifocal cerebral infarcts

heparin anticoagulation

occult malignancy

cancer-associated thrombosis

Trousseau Syndrome

Malignancy

Hypercoagulable State

Thrombotic Event

Cancer-Associated Thrombosis