Presentation
The patient presented with right arm swelling. Heavy smoker patient with no significant previously known medical conditions.
Patient Data
Heterogeneously enhancing mass in the right lower lobe measuring about 8 x 7.5 x 3 cm (AP.TRANS.CC), associated with mild to moderate right pleural effusion, and collapse of the right lower lobe.
Multiple right cardiophrenic, right internal mammary, bilateral hilar and mediastinal, right supraclavicular and right cervical lymph nodes are noted, the largest measures about 3.5 x 2 cm.
Marked thrombosis of the right internal jugular, subclavian and axillary veins is noted, with surrounding fat stranding, consistent with thrombophlebitis (Trousseau syndrome).
Bilateral adrenal heterogeneously enhancing lesions are noted, measuring 2.8 x 2.5 cm on the right and 3 x 2.7 cm on the left, consistent with adrenal metastases.
2.8 x 2.7 cm cyst in the liver is noted, no definite hepatic metastatic deposits could be seen.
Conclusion:
Right lung lower lobe cancer; T4, N3, M1c (stage IVb), with thrombophlebitis of the right IJV, subclavian and axillary veins (Trousseau syndrome) and right pleural effusion and right lower collapse.
Case Discussion
Adenocarcinomas of the stomach, pancreas, and lung are the commonest causes of Trousseau syndrome. It is considered as a paraneoplastic syndrome, and its typical manifestation is recurrent and migrating episodes of thrombophlebitis/DVT that mainly involve the upper and lower limbs, chest wall, abdominal wall, and the major blood vessels of the abdomen 1.
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