[Venous thromboembolic disease and occult cancers: what investigations should be done? Apropos of 204 patients].
There is no consensus about the investigations which should be performed to detect occult malignancy after an episode of venous thromboembolism. The authors studied 204 patients (167 in-patients and 37 day hospital patients) with deep venous thrombosis or pulmonary embolism to determine the incidence of cancers detected during or after the thrombosis and the diagnostic value of abdomino-pelvic ultrasonography. Of the 167 in-patients, 18 (10.7%) had a known malignancy. After the initial investigations, 7 tumours were detected (4.6%). In all cases, clinical history and examination or chest X-ray were suggestive of neoplasia. Abdomino-pelvic ultrasonography did not detect any cases of occult malignancy. Of the 37 patients seen in the day hospital, only one had known malignant disease and no other cases were detected. After exclusion of the 26 patients with known malignancies or tumours discovered after the initial investigations, the remaining 178 patients were followed up for an average of 27 months. Four cancers (2.5%) were detected in this period. The authors conclude that the occurrence of deep venous thrombosis should lead to investigation for malignant disease: clinical examination, chest X-ray and laboratory tests are sufficient to orientate this investigation. Systematic abdominopelvic ultrasonography does not seem to be worthwhile in this indication.
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Service da médecine vasculaire et centre Claude-Bernard de recherche sur les maladies vasculaires, CHU Broussais, Paris.
Emmerich
J
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Oger
E
E
Fiessinger
J N
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D000005:Abdomen / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000150:complications / Q000175:diagnosis; D010388:Pelvis / Q000000981:diagnostic imaging; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology*; D014463:Ultrasonography