0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
Trousseau Syndrome 1453tests
Laboratory Studies
■Most studies non-specific & unrevealing
■Approx 40–60% pts may demonstrate features of DIC characterized
by prolongation of prothrombin time, activated partial thrombo-
plastin & thrombin time; hypofibrinogenemia & appreciable ele-
vated quantities of fibrinogen-fibrin degradation products in the
serum
■Histologic evidence of neoplastic tissue is essential to make Dx of
Trousseau syndrome.
differential diagnosis
■Thrombophlebitis
■Acute arterial occlusion
■Pulmonary emboli
■All known neoplastic diseases
■CNS stroke
■Non-bacterial thrombotic endocarditis
■SBE
■Anti phospholipid syndrome
■Budd-Chiari syndrome
management
■Venography promptly indicated: whenever indicated any place in
body (usually initially lower extremities). PET imaging to locate pri-
mary and extent of metastases. Removal of primary may provide
therapeutic benefit.
■Presence of distended venous network; in particular, if there are ten-
der cutaneous erythematous streaks
■If prob involves both lower extremities simultaneously: prompt
intense investigation for presence of a neoplasm must be initiated.
■The primary may be in any organ.
■In order of frequency, following must be exhaustively studied:
➣Lung; stomach; prostate; pancreas; blood (for acute leukemia);
colon; ovary; gall bladder; liver; cholangiocarcinoma; reticulum
cell carcinoma; melanoma; neuroblastoma; hepatoma; breast;
tonsil; & site for unknown primary
■If any invasive studies needed: do immediately
■Tumor markers – employing noninvasive techniques such as CEA,
PSA, chest radiography, upper GI endoscopy, abdominal ultrasound,
and computed axial tomography scan may be very helpful in early
detection of neoplasia