Abstract Details

Title Trousseau Syndrome with the MR Three-territory Sign as the Initial Manifestation of an Occult Pancoast Tumor: A Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-026

Objective To present this interesting case of a young female patient who presented with the MR three-territory sign and was found to have an occult Pancoast tumor.

Background Pancoast tumors are rare tumors, representing 3% to 5% of bronchogenic carcinomas, located in the apex of the lung. Trousseau syndrome refers to cancer-associated arteriovenous thromboembolism. There are few cases reporting trousseau syndrome with cerebral infarction as the initial manifestation of occult tumors. Cerebral infarctions involving three vascular territories on MR diffusion-weighted imaging (DWI) are called “three-territory sign” (TTS). In the absence of an embolic source, this sign is almost always due to stroke related to cancer-associated hypercoagulation (CAH).

Design/Methods Case Report

Results A 35-year-old female patient was admitted to our neurology department at Mansoura University Hospitals due to two attacks of right-side hemiparesis and hemihypoesthesia associated with right upper motor neuron facial involvement, four months apart. The first attack regressed completely after vascular treatment. In the second attack, she presented with global aphasia and one attack of right focal to bilateral motor tonic colonic seizure. The condition was preceded by unexplained DVT affecting both lower limbs sequentially six months before the admission. She wasn’t on contraceptive pills. When MR-DWI was done, multiple restricted diffusion lesions involving bilateral anterior and posterior circulations were found. Echocardiography was normal. She underwent pan-CT, which revealed a suspicious mass in the apex of the right lung (Pancoast tumor) with hilar lymphadenopathy. She underwent CT-guided fine needle aspiration, and core needle biopsy which revealed undifferentiated malignant tumor. Unfortunately, she died shortly after the biopsy.

Conclusions TTS is a highly specific marker that is frequently found in malignancy-related ischemic stroke, yet it’s still an overlooked diagnostic feature. Hence, once TTS is found, a Transesophageal Echocardiogram should be done to exclude cardioembolic causes, as well as a pan-CT to confirm or exclude occult malignancy.

Authors/Disclosures
Hadeer Elsaeed AboElfarh, MD (Mansoura Faculty of Medicine) PRESENTER	Dr. AboElfarh has nothing to disclose.
Dena Elghzzawy	No disclosure on file
Mohamed Abokhalil	No disclosure on file
Basma Elged	No disclosure on file
Ayat Elbasyouni	No disclosure on file
Ibrahim E. El-Menshawi, MD (Mansoura University)	Dr. El-Menshawi has nothing to disclose.

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