Bandara Asela Rasika, Wimalarathna Harith, Kalupahana Ranjith, Gunathilake Sonali Sihindi Chapa
Teaching Hospital, Kandy, 20000, Sri Lanka.
J Med Case Rep. 2016 Apr 21;10(1):104. doi: 10.1186/s13256-016-0884-9.
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.
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.
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.
颈内静脉血栓形成是一种罕见的血管事件，可能导致致命后果。在已知的病因中，已知或隐匿的内部恶性肿瘤时有详尽描述。尽管已知恶性肿瘤可表现为颈内静脉血栓形成，但因前列腺癌导致的情况很少见。许多继发于恶性肿瘤的颈静脉和上腔静脉血栓形成病例是由于静脉的转移性压迫。与恶性肿瘤相关的高凝状态导致的复发性和不寻常的血管血栓形成也被称为特鲁索综合征。在此，我们报告一例罕见病例，一名患者以颈内静脉血栓形成为转移性前列腺癌的首发表现，这是一例特鲁索综合征病例。
一名75岁的斯里兰卡男性，患有高血压、高脂血症，既往有自发性颅内出血病史，因左锁骨上窝无痛性肿胀病史较短前来就诊。检查发现肿胀是由于左侧颈外静脉增厚所致。双功超声扫描显示左侧颈内静脉、颈外静脉和头臂静脉血栓形成。对潜在恶性肿瘤的监测发现前列腺不规则、坚硬，怀疑为前列腺癌，经组织学和生化检查得以证实。计算机断层扫描发现广泛的椎体、骨盆骨、腹腔内淋巴结转移以及右侧下肺单个转移病灶，颈静脉未直接受累。
由特鲁索综合征引起的颈内静脉自发性血栓形成罕见且不寻常。临床医生应及时对恶性肿瘤进行调查，因为它可能是潜在隐匿性恶性肿瘤的首发表现。尽管前列腺癌很少表现为颈内静脉血栓形成，但本病例说明了在适当的临床环境中保持高度怀疑的重要性。
