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Venous Thromboembolism and Occult Malignancy: Simultaneous Detection During Pulmonary CT Angiography with CT Venography

Guillaume Bierry1, Nathalie Holl1, Frauke Kellner2, Sophie Riehm1, Marie-Noelle Roedlich1, Michel Greget1 and Francis Veillon1

1 Department of Radiology 1, University Hospital of Strasbourg, 10 Ave. Molière, 67098 Strasbourg Cedex, France.
2 Department of Radiology, Inselspital Bern, Bern, Switzerland.


Figure 1
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  		Fig. 1A —Simultaneously discovered pancreatic carcinoma, deep venous thrombosis, and pulmonary embolism in 45-year-old woman presenting with sudden shortness of breath and elevated D-dimers. Pulmonary artery CT angiography image shows left pulmonary artery thrombosis (arrow).

 

Figure 2
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  		Fig. 1B —Simultaneously discovered pancreatic carcinoma, deep venous thrombosis, and pulmonary embolism in 45-year-old woman presenting with sudden shortness of breath and elevated D-dimers. On CT venography (CTV) image, tissue lesion of pancreas head (arrow) proven to be pancreatic carcinoma with mild biliary and pancreatic tract dilatation was identified.

 

Figure 3
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  		Fig. 1C —Simultaneously discovered pancreatic carcinoma, deep venous thrombosis, and pulmonary embolism in 45-year-old woman presenting with sudden shortness of breath and elevated D-dimers. Partial thrombosis of right iliac vein (arrow) was simultaneously detected during CTV.

 

Figure 4
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  		Fig. 2A —Lung carcinoma with deep venous thrombosis in 66-year-old man who presented with atypical chest pain. Pulmonary artery CT angiography image shows tissue lesion of right lower lobe (arrow) that was confirmed to be non-small-cell lung carcinoma at transbronchial biopsy.

 

Figure 5
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  		Fig. 2B —Lung carcinoma with deep venous thrombosis in 66-year-old man who presented with atypical chest pain. CT venography image shows thrombosis of superficial and deep right femoral veins appearing as intraluminal contrast media void with surrounding contrast rim (arrow).

 

Figure 6
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  		Fig. 3A —Hepatic metastases from occult breast carcinoma with concomitant deep venous thrombosis and pulmonary embolism in 76-year-old woman who presented with right upper quadrant pain with elevated D-dimers. Pulmonary artery CT angiography image shows bilateral pulmonary artery embolism (arrows).

 

Figure 7
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  		Fig. 3B —Hepatic metastases from occult breast carcinoma with concomitant deep venous thrombosis and pulmonary embolism in 76-year-old woman who presented with right upper quadrant pain with elevated D-dimers. CT venography (CTV) image shows left popliteal venous thrombosis (arrow).

 

Figure 8
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  		Fig. 3C —Hepatic metastases from occult breast carcinoma with concomitant deep venous thrombosis and pulmonary embolism in 76-year-old woman who presented with right upper quadrant pain with elevated D-dimers. CTV also detected multiple hypovascular hepatic nodules with metastases (arrows).

 

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