A 57-year-old man with weight loss and back pain develops recurrent, migrating tender cord-like induration in different limb veins over several weeks. Biopsy of one cord shows a sterile thrombosed superficial vein. Which investigation should be prioritised next?

• A Contrast CT scan of abdomen for pancreatic carcinoma ✓
• B Duplex ultrasound of the affected vein alone
• C Skin biopsy for fungal stains
• D Serum calcium and parathyroid hormone levels

Explanation

Migratory superficial thrombophlebitis, the Trousseau sign, is a classic marker of occult visceral malignancy, most commonly adenocarcinoma of the pancreas body or tail; recurrent migration and absence of local risk factors demand a search for cancer, with contrast CT of the abdomen as the key step. Imaging the vein alone treats the clue as the disease and would miss the tumour driving it.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.