Internal jugular venous thrombosis due to Trousseau's syndrome as the presenting feature of metastatic prostate carcinoma: a case report.
BACKGROUND
Internal jugular vein thrombosis is a rare vascular event with a potentially fatal outcome. Of the known etiologies, internal malignancies, either known or occult, are well described. Even though malignancies are known to present with internal jugular vein thrombosis, it rarely occurs due to prostate carcinoma. Many cases of jugular vein and superior vena cava thrombosis secondary to malignancies are due to metastatic compression of veins. Recurrent and unusual vascular thrombosis due to hypercoagulability associated with malignancies is also known as Trousseau's syndrome. Here we report a rare case of a patient with internal jugular vein thrombosis as a presenting feature of metastatic prostate carcinoma, which is a case of Trousseau's syndrome.


METHODS
A 75-year-old Sri Lankan man with hypertension, hyperlipidemia, and past history of spontaneous intracranial hemorrhage presented with a short history of painless swelling in his left supraclavicular fossa. An examination revealed the swelling was due to a thickened left external jugular vein. A duplex ultrasound scan revealed left-sided internal jugular, external jugular, and brachiocephalic venous thrombosis. Surveillance into underlying malignancies showed an irregular, hard prostate gland suspicious of prostate carcinoma, which was proven with histology, and biochemically. A computed tomography scan found extensive vertebral, pelvic bone, intra-abdominal lymph node metastasis, and a single right-sided lower lung metastatic lesion, with no direct involvement of the jugular vein.


CONCLUSIONS
Spontaneous thrombosis of the internal jugular vein due to Trousseau's syndrome is rare and unusual. Clinicians should promptly investigate for malignancies as it can be the first presentation of underlying occult malignancies. Although prostate carcinomas are rare to present with internal jugular vein thrombosis, this case illustrates the importance of having a high degree of suspicion in the appropriate clinical setting.
Teaching Hospital, Kandy, 20000, Sri Lanka. arbandara86@gmail.com.
Asela Rasika
AR
Bandara
Teaching Hospital, Kandy, 20000, Sri Lanka.
Harith
H
Wimalarathna
Teaching Hospital, Kandy, 20000, Sri Lanka.
Ranjith
R
Kalupahana
Teaching Hospital, Kandy, 20000, Sri Lanka.
Sonali Sihindi Chapa
SS
Gunathilake
D000230:Adenocarcinoma / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000556:secondary; D000368:Aged; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000556:secondary; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D013577:Syndrome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology
D017430:Prostate-Specific Antigen
Hypercoagulability; Internal jugular vein thrombosis; Migratory thrombophebitis; Prostate cancer; Trousseau’s syndrome