What lies beneath a deep vein thrombosis

Presentation We describe a case of non-small cell lung carcinoma (NSCLC) initially presenting with migratory VTE in a previously healthy never smoker. This case demonstrated unexpected wisespread metastatic spread to a variety of unusual sites which have only been rarely reported in the literature.

Diagnosis Initial doppler ultrasound confirmed lower limb deep vein thrombosis. Subsequent CTPA revealed pulmonary embolism and a suspicious lung lesion which was later confirmed as NSCLS on histology. PET CT revealed extensive metastatic disease.

Treatment Therapeutic anticoagulation was the mainstay of therapy along with symptom management.

Discussion Malignancy is linked with venous thromboembolism (VTE) by a two way clinical association . Trousseau Syndrome, which is inconsistently defined in the literature, is considered a paraneoplastic phenomenon manifesting as hypercoagulability in the context of underlying malignancy. Our patient was previously well with no identifiable risk factors for venous thromboembolism or lung cancer. This highlights the importance of high clinical suspicion for an underlying cause even in the most benign appearing cases of venous thromboembolism.