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December 11, 1967

Bronchogenic Carcinoma and Thromboembolic Disease

Author Affiliations

From the Section of Medicine, Mayo Clinic and Mayo Foundation (Drs. Divertie and Spittell), and Mayo Graduate School of Medicine, University of Minnesota (Dr. Byrd), Rochester.

JAMA. 1967;202(11):1019-1022. doi:10.1001/jama.1967.03130240061011

During a six-year period, thromboembolism occurred as an early complication in 37 patients with primary bronchogenic carcinoma. No other precipitating factor was identified, and only three of the 37 patients had previously undergone surgery. In 14 instances, an episode of thrombophlebitis first called attention to the patient's illness. Migratory thrombophlebitis involving unusual sites and resistant to anticoagulant therapy often preceded recognition of the tumor by as long as 18 months. The presence of thrombophlebitis was associated with a poor prognosis. The mechanism is obscure, but in three cases there was acceleration of factor III (thromboplastin) generation. No relationship was apparent between the histologic structure of the tumor and the frequency of venous thromboembolism. Even when lymph nodes are not palpable, bilateral supraclavicular exploration and lymph node biopsy appears to be a valuable and innocuous diagnostic procedure in patients with unexplained thrombophlebitis and is preferable to abdominal exploration. The true incidence of this complication is difficult to assess because of the uncertainties of retrospective diagnosis and follow-up.