A80-3-03 From a Thrombotic Hurricane to Pulmonary Adenocarcinoma: A Case of Trousseau Syndrome

Abstract Introduction Trousseau syndrome represents a paraneoplastic thrombotic complication first described by Armond Trousseau in 1865. The management can be exquisitely challenging, especially when the underlying malignancy cannot be eliminated. Herein, we present a rare case of Trousseau syndrome leading to the diagnosis of pulmonary adenocarcinoma. Case Description A 73-year-old female presented with left lower extremity pain over the past 12 hours. Objectively, she had stable vitals signs. Physical exam was significant for cool left lower extremity with absent dorsalis pedis and posterior tibial pulses. CT angiogram reveals thrombotic occlusion of distal left common iliac artery, anterior tibial, and peroneal arteries. The patient underwent catheter-directed thrombolysis of the left lower extremity and mechanical thrombectomy of left common iliac and popliteal arteries, with stent insertion in left common iliac and superficial femoral arteries (SFA). Intravenous heparin infusion was continued. To evaluate for potential sources of thromboembolism, a CT chest, abdomen, pelvis reveals a large right sided pleural effusion with complete collapse of right middle and lower lobes. Furthermore, there was a spiculated mass 2.0x2.4 cm in right upper lobe. The patient underwent US-guided thoracentesis with drainage of 1.5L of exudative pleural fluid. Subsequent cytological evaluation of pleural fluid was positive for pulmonary adenocarcinoma. On day 7 of hospitalization, left posterior tibial and dorsalis pedis pulses were absent and a follow up CT angiogram revealed new occlusion of the left SFA stent. Intra-operative angiography confirmed SFA occlusion with thrombus in left proximal popliteal artery, anterior tibial and posterior tibial arteries. Given the significant thrombus burden, she remained on continuous catheter directed thrombolysis post-operatively. A follow-up arteriogram demonstrated patency of the left SFA stent. Catheter directed thrombolysis was changed to heparin infusion, which was later transitioned to enoxaparin 1 mg/kg twice daily due to an underlying suspicion of Trousseau syndrome. Upon goals of care discussion, a decision was made to proceed with hospice care. The patient was discharged in a hemodynamically stable condition. Discussion Trousseau syndrome has been notably associated with mucinous solid tumors (e.g. pancreatic, ovarian) which was uniquely not found in our case. Unfractionated heparin followed by low-molecular weight heparin are considered the preferred treatment. However, despite being on intravenous heparin infusion, our case demonstrated new thrombotic events that required continuous catheter directed thrombolysis post-operatively. This case emphasizes the importance of monitoring for malignant thrombotic complications and the need to involve a multi-disciplinary team to mediate early initiation of treatment and optimize clinical outcomes. This abstract is funded by: None