Paraneoplastic thrombosis of the internal jugular and subclavian veins as first manifestation of gall bladder cancer

摘要

HISTORY AND CLINICAL FINDINGS: A 69-year-old woman presented with a cervical swelling of unknown cause. INVESTIGATION AND DIAGNOSIS: Computed tomograph (CT) and phlebography showed extensive thrombosis of sigmoid sinus and the internal jugular, brachiocephalic and subclavian veins on the left side. Blood coagulation tests were unremarkable. A paraneoplastic cause for the thrombosis could be ruled out as well. The CT revealed only cholecystolithiasis and anadrenal incidentaloma. TREATMENT AND COURSE: Oral anticoagulation was initiated. One year later a carcinoma of the gall bladder with involvement of the liver was detected at laparoscopic cholecystectomy. Reoperation was performed but not all tumor tissue was resected. Nine months later an intraabdominal metastasis was excised. CONCLUSION: If a paraneoplastic thrombosis but susected but the search for a tumor has been unsuccessful, even an asymptomatic cholecystolithiasis should be treated with a cholecystectomy.