Recurrent Venous Thromboembolism as the Initial Clinical Presentation of Gastric Cancer: A Case Report

Document Type : Case Report


1 Pulmonologist, Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Residency of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Pulmonary thromboembolism (PTE) is a clinically critical disease, misdiagnosis or delayed diagnosis of which can lead to increased rate of mortality. For prevention of recurrence of PTE, recognition of its risk factors or underlying diseases is of great importance. PTE is common in patients with cancer and has high morbidity and mortality rates. Although cancer is a lethal condition, PTE accelerates death in these patients. In the current study, we reported the case of a 50-year-old male presenting with dyspnea, pleuritic chest pain, and non-massive hemoptysis indicating pulmonary embolism. Anticoagulant therapy was initiated, but after 12 days of treatment, new deep vein thromboses in the left upper and right lower limbs were diagnosed. However, no specific risk factors or laboratory abnormalities were detected. History of weight loss during the recent months encouraged further investigation for ruling out malignancy, which led a diagnosis of gastric adenocarcinoma. He did not have any complaints of gastrointestinal disorders.


  1. Pezeshki Rad M, Farrokh Tehrani D, Reihani H, Faghih Sabzevari SH, Rajabi M. Incidental findings in patients evaluated for pulmonary embolism using computed tomography angiography. J Cardio Thorac Med. 2014; 2:162‐6.
  2. Keskin S, G Ler T, Kalkan H, Keskin Z, Odev K. Pulmonary embolism and hematologic outcome in cancer patients initiating chemotherapy. Indian J Cancer. 2014; 51:303-5.
  3. Pabinger I, Thaler J, Ay C. Biomarkers for prediction of venous thromboembolism in cancer. Blood. 2013; 122:2011-8.
  4. Font C, Carmona-Bayonas A, Plasencia JM, Calvo-Temprano D, Sánchez M, Jiménez-Fonseca P, et al. Pulmonary embolism in patients with cancer: foundations of the EPIPHANY study. Med Clin. 2015; 144:31-7.
  5. Saka M, Morita S, Fukagawa T, Nijjar R, Katai H. Incidence of pulmonary thromboembolism in gastric cancer surgery using routine thromboprophylaxis. Gastric Cancer. 2010; 13:117-22.
  6. O'Connell CL, Liebman HA. Approach to the management of incidental venous thromboembolic events in patients with cancer. J Natl Compr Canc Netw. 2014; 12:1557-60.
  7. Larsen AC, Dabrowski T, Frøkjær JB, Fisker RV, Iyer VV, Møller BK, et al. Prevalence of venous thromboembolism at diagnosis of upper gastrointestinal cancer. Br J Surg. 2014; 101:246-53.
  8. Khanna A, Reece-Smith AM, Cunnell M, Madhusudan S, Thomas A, Bowrey DJ. Venous thromboembolism in patients receiving perioperative chemotherapy for esophagogastric cancer. Dis Esophagus. 2014; 27:242-7.