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Teachable Moment
Less Is More
June 2016

Cancer Screening After Unprovoked Venous Thromboembolism: A Teachable Moment

Author Affiliations
  • 1School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 2Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • 3Thrombosis Program, Division of Hematology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
JAMA Intern Med. 2016;176(6):739-740. doi:10.1001/jamainternmed.2016.1783

A 68-year-old man recently discharged from the emergency department with an acute, unprovoked pulmonary embolism (PE) was seen as an outpatient for a follow-up visit. He had no clinically significant medical history (including prior venous thrombosis or cancer). The patient was prescribed warfarin with a good therapeutic level, and his PE-related symptoms were improving. Results from his physical examination, as well as from his basic blood tests, including complete blood cell count, liver function tests, and renal function, were all normal. His prostate-specific antigen level was also within normal limits. A computed tomographic (CT) image of the abdomen and pelvis was requested to investigate for potential occult cancers. The CT imaging revealed a slight irregularity at the tail of the pancreas, including definite evidence of dilated branches of the pancreatic duct. The pancreatic duct was approximately 3 mm in diameter and suggestive of an intraductal obstructive lesion, presumably from neoplastic disease. The results were discussed with the patient and created substantial anxiety, stress. and fear for him and his family. The patient was referred to a general surgeon for further assessment. Results from both magnetic resonance imaging and endoscopic ultrasonography of the abdomen confirmed focal ectasia of the pancreatic branch ducts without any evidence of cancer.

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