Alagha Zakaria, Avalishvili Tata, Crow Samuel, Gundakaram Samhitha, McIntosh Thomas, Ghallab Muhammad, Shweihat Yousef, Mustafa Bisher, Al-Astal Amro, Mahdi Ahmed
Internal Medicine Department, Joan Edwards School of Medicine, Huntington, WV, USA.
Pulmonary and Critical Care Medicine Department, Joan Edwards School of Medicine, Huntington, WV, USA.
J Investig Med High Impact Case Rep. 2025 Jan-Dec;13:23247096251340739. doi: 10.1177/23247096251340739. Epub 2025 May 21.
Recurrent deep vein thrombosis (DVT) is a common complication, particularly in cancer patients. We present a case of a 50-year-old male with a history of a previous DVT. Despite therapeutic anticoagulation with apixaban, the patient developed recurrent DVT involving the common femoral, popliteal, and foreleg veins. He was started on a heparin drip in the hospital, but despite this, his DVT worsened. Imaging studies revealed mediastinal and hilar lymphadenopathy, raising suspicion of malignancy. The workup revealed elevated tumor markers, while the thrombophilia panel was unremarkable. Despite aggressive management, including mechanical thrombectomy, catheter-directed thrombolysis, and the placement of an inferior vena cava filter, the patient's condition continued to deteriorate. A biopsy of the mediastinal lymph nodes revealed poorly differentiated mucinous adenocarcinoma with molecular analysis consistent with hepatobiliary origin, and the patient was diagnosed with stage IVB gallbladder cancer. Given the rarity of gallbladder cancer and its association with hypercoagulability, this case highlights the importance of considering cancer as an underlying cause of recurrent DVT after ruling out common causes. Early recognition and a comprehensive diagnostic approach are essential for managing such cases. The patient was started on chemotherapy while maintaining anticoagulation for recurrent DVT.
复发性深静脉血栓形成（DVT）是一种常见并发症，尤其在癌症患者中。我们报告一例50岁男性，既往有DVT病史。尽管使用阿哌沙班进行了抗凝治疗，但患者仍出现了复发性DVT，累及股总静脉、腘静脉和前腿静脉。他在医院开始接受肝素静脉滴注，但尽管如此，他的DVT仍恶化。影像学检查显示纵隔和肺门淋巴结肿大，怀疑有恶性肿瘤。检查发现肿瘤标志物升高，而血栓形成倾向检查结果无异常。尽管采取了积极的治疗措施，包括机械血栓切除术、导管定向溶栓和下腔静脉滤器置入，但患者的病情仍继续恶化。纵隔淋巴结活检显示为低分化黏液腺癌，分子分析与肝胆来源一致，患者被诊断为IVB期胆囊癌。鉴于胆囊癌的罕见性及其与高凝状态的关联，该病例突出了在排除常见原因后将癌症视为复发性DVT潜在原因的重要性。早期识别和全面的诊断方法对于处理此类病例至关重要。患者开始接受化疗，同时维持针对复发性DVT的抗凝治疗。
