Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1452 Tricuspid Valve Stenosis (TS) Trousseau Syndrome

follow-up

n/a

complications and prognosis

■Overall prognosis usually depends on other conditions (rheumatic

involvement of other valves and left ventricular function, or carci-

noid syndrome)

TROUSSEAU SYNDROME

WILLIAM BELL, PhD, MD

history & physical

History

■Characterized by recurrent migratory thrombophlebitis – thrombo-

sis simultaneously in superficial and deep veins & arterial systems

in any anatomic location

■Associated with underlying neoplastic disease

■Patient complains of:

➣painful venous cords often associated with linear erythematous

cutaneous streaks accompanied by cold distal extremities with

absence of arterial pulse in involved area

➣Rarely: fever, weight loss, headache, decline in appetite or any

other systemic constitutional signs & symptoms

Signs & Symptoms

■Usually no systemic complaints

■Most commonly: normal, healthy-appearing pt; normal vital signs.

Occasionally, minimal, questionable weight loss.

■Most common: palpable venous cords; exquisitely tender to minimal

manipulation

➣Often venous or arterial cord can be picked up by examiner’s

fingers

➣Heat immed above cut surface over involved vessel

➣Cutaneous erythematous streaks

➣Minimal to modest degree of edema (surrounding & distal to

involved site)

➣Flexion & distention of involved site – painful

➣Body weight cannot be supported without discomfort

➣Reasonably frequent: concomitant overlapping thromboph-

lebitis, arterial emboli, etc.