Trousseau's Syndrome in Cholangiocarcinoma: The Risk of Making the Diagnosis.
We report a case of Trousseau's syndrome with cholangiocarcinoma complicated by a fatal pulmonary embolism after liver biopsy. A 69-year-old man who presented with right upper quadrant pain was found to have portal vein thrombosis and nonspecific liver hypodensities after imaging by computerized tomography. Following four days of anticoagulation, heparin was held for percutaneous liver biopsy. After the biopsy, he developed acute hepatic failure, acute kidney injury, lactic acidemia, and expired. Autopsy revealed intrahepatic cholangiocarcinoma and a pulmonary embolism. Trousseau's syndrome with cholangiocarcinoma is rarely reported and has a poor prognosis. This case highlights a fundamental challenge in the diagnosis and early management of intrahepatic cholangiocarcinoma with hypercoagulability. Diagnostic biopsy creates an imperative to reduce post-operative bleeding risk, but this conflicts with the need to reduce thrombotic risk in a hypercoagulable state. Considering the risk of withholding anticoagulation in patients with proven or suspected cholangiocarcinoma complicated by portal vein thrombosis, physicians should consider biopsy procedures with lesser bleeding risks, such as transjugular liver biopsy or plugged percutaneous liver biopsy, to minimize interruption of anticoagulation.
['Blum|Matthew F|MF|', 'Ma|Vincent Y|VY|', 'Betbadal|Anthony M|AM|', 'Bonomo|Robert A|RA|', 'Raju|Rajeeva R|RR|', 'Packer|Clifford D|CD|']
D000368:Aged D000925:Anticoagulants D001706:Biopsy D001707:Biopsy, Needle D018281:Cholangiocarcinoma D006493:Heparin D006801:Humans D008099:Liver D008297:Male D010689:Phlebitis D049268:Positron-Emission Tomography D011379:Prognosis D011655:Pulmonary Embolism D012306:Risk D014057:Tomography, X-Ray Computed
Cholangiocarcinoma Biopsy Portal vein Heparin Large-Core Needle Venous thrombosis