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  Table of Contents  
IMAGES IN ONCOLOGY
Year : 2018  |  Volume : 55  |  Issue : 4  |  Page : 415-416
 

Trousseau's sign in the left internal jugular vein in gastric cancer


Department of Radiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication28-Feb-2019

Correspondence Address:
Dillibabu Ethiraj
Department of Radiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_321_18

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How to cite this article:
Ethiraj D, Indiran V, Kanakaraj K, Madhuraimuthu P. Trousseau's sign in the left internal jugular vein in gastric cancer. Indian J Cancer 2018;55:415-6

How to cite this URL:
Ethiraj D, Indiran V, Kanakaraj K, Madhuraimuthu P. Trousseau's sign in the left internal jugular vein in gastric cancer. Indian J Cancer [serial online] 2018 [cited 2019 Aug 25];55:415-6. Available from: http://www.indianjcancer.com/text.asp?2018/55/4/415/253290




A 24-year-old woman came with complaints of upper abdominal swelling for the last 6 months, early satiety associated with loss of appetite and weight for 3 months, abdominal pain for the last 1 month, and vomiting for the last 4 days. Abdominal examination revealed a centrally placed solid swelling in the epigastric region with mild tenderness. Abdominal ultrasound and contrast-enhanced computed tomography (CECT) abdomen showed multiple liver secondaries and diffuse circumferential gastric wall thickening and enlarged peripancreatic and periportal nodes [Figure 1]. Ultrasound of neck and Doppler and CECT neck showed partial thrombus in the left internal jugular vein thrombosis (IJVT) proximal to its origin for a length of about 1.7 cm [Figure 2]a and [Figure 2]b. Upper gastrointestinal scopy showed ulceroproliferative growth in the body, antrum, and pylorus region with features of infiltrating adenocarcinoma of poorly differentiated diffuse type on biopsy.
Figure 1: Contrast-enhanced computed tomography of the abdomen shows heterogeneously enhancing circumferential greater and lesser curvature wall thickening (blue arrow), multiple enlarged periportal and peripancreatic nodes, and liver metastases (red arrow)

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Figure 2: Doppler (a) and axial contrast-enhanced computed tomography of the neck (b) show partial thrombus in the left internal jugular vein (orange arrow)

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Gastric carcinoma is the second most common cause of cancer-related death worldwide.[1] Advanced gastric carcinoma commonly presents with outlet obstruction, dyspeptic symptoms, and features of metastasis with IJVT being an uncommon presentation.[2]

Trousseau first reported the migratory thrombophlebitis associated with gastric carcinoma.[3] Virchow suggested that hypercoagulability due to stasis, tumor cell activation, and vessel wall injury are responsible for thrombosis in patients with malignancy.[2] Deep vein thrombosis commonly affects the lower limbs. Head and neck veins are less prone to thrombosis as they are usually valve-less and gravity-prone.[4] Venous thrombosis can have serious life-threatening complications like chylothorax, airway edema, systemic sepsis, and pulmonary embolism.[5] Doppler ultrasonography is an excellent diagnostic method for IJVT with sensitivity of 97% but has limits in the subclavian vein and superior vena cava evaluation where CECT and magnetic resonance imaging are helpful.[4],[6] Zyrianov et al.[7] in their study of 108 patients with gastric carcinoma found that deep venous thrombosis of the lower limbs was seen in 37% of the cases. However, literature correlating with IJVT and stomach cancer is limited.[2],[8] In this patient, left IJVT was found during evaluation for Virchow's nodes. Thrombosis may present with or without thrombus-related symptoms as seen in our case. Anticoagulation is the main treatment of choice for venous thrombosis. Heparinization is used widely, followed by anticoagulation with warfarin. Anticoagulation could prevent complications from thrombosis such as septic embolism and pulmonary embolism.[8] As pulmonary embolism is a life-threatening complication of jugular venous thrombosis, it is important to be aware of the thrombotic tendency in patients with gastric malignancy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dikshit RP, Mathur G, Mhatre S, Yeole BB. Epidemiological review of gastric cancer in India. Indian J Med Paediatr Oncol 2011;32:3-11.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Vikram S, Jacob P, Nair CG, Vaidyanathan S. Gastric carcinoma – A rare presentation. Indian J Surg Oncol 2010;1:346-8.  Back to cited text no. 2
    
3.
Sack GH Jr., Levin J, Bell WR. Trousseau's syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: Clinical, pathophysiologic, and therapeutic features. Medicine (Baltimore) 1977;56:1-37.  Back to cited text no. 3
    
4.
Modayil PC, Panthakalam S, Howlett DC. Metastatic carcinoma of unknown primary presenting as jugular venous thrombosis. Case Rep Med 2009;2009:938907.  Back to cited text no. 4
    
5.
Sheikh MA, Topoulos AP, Deitcher SR. Isolated internal jugular vein thrombosis: Risk factors and natural history. Vasc Med 2002;7:177-9.  Back to cited text no. 5
    
6.
Liu KT, Chan HM, Lin TJ. An unusual presentation of metastatic gastric adenocarcinoma – Acute onset of right neck swelling. J Formos Med Assoc 2007;106:589-91.  Back to cited text no. 6
    
7.
Zyrianov BN, Tsisik RM, Udut VV, Karpov AB. Venous thromboses of the lower extremities in stomach cancer patients. Vopr Onkol 1990;36:872-5.  Back to cited text no. 7
    
8.
Mamede RC, Resende e Almeida KO, de Mello-Filho FV. Neck mass due to thrombosis of the jugular vein in patients with cancer. Otolaryngol Head Neck Surg 2004;131:968-72.  Back to cited text no. 8
    


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