Predictive value of deep venous thrombosis for the later development of pancreatic cancer: a case report

Introduction: Recent data have shown that pancreatic cancer is the malignancy with the greatest incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE), with as many as 40% of pancreatic cancer patients being affected. In some cases, DVT is diagnosed months or even years before the cancer. Case report: A 58-year-old male patient presented in January 2016 with pain, swelling, reddening and loss of function of the left inferior limb. A venous ultrasonography was performed, revealing a thrombus in the superficial femoral vein. The patient has a long history of multiple recurring venous thromboses: at the end of 2013 he presented with almost simultaneous thromboses of the left upper limb and right lower limb. He was screened then for cancer using conventional radiology, CT, abdominal ultrasonography and tumor markers, with no result. In September 2015 the patient was admitted for abdominal pain and supraclavicular tumor with signs of Horner's syndrome. A superficial venous thrombosis was diagnosis, despite the well-controlled anticoagulant treatment. Abdominal ultrasound examination showed a pancreatic tumor and radiology showed a pulmonary tumor that were biopsied, revealing a pancreatic ductal adenocarcinoma with pulmonary metastases. A lifelong treatment with subcutaneously injected LMWH was recommended and palliative chemotherapy was initiated. Conclusion: We report here a case of multiple migratory venous thromboses developed almost two years before a diagnosis of malignancy was made. This shows the importance of regular follow-ups and screening for occult malignancies after the occurrence of idiopathic DVT.