Original article Prostatic adenocarcinoma masquerading as lymphoma and presentation with axillary-subclavian vein thrombosis

Axillary and/or subclavian vein thrombosis is a relatively rare disease, constituting about 2% of all cases of deep venous thrombosis (DVT). We report on a patient who presented with axillary-subclavian vein thrombosis and had metastatic prostatic adenocarcinoma. © 2003 Elsevier Science Inc. All rights reserved. 1. Case report A 59-year-old white male presented to the medical unit complaining of a swollen left arm and "bruising" around his left shoulder. There was no history of trauma. He denied any urinary symptoms, backache, chest pain, and or weight loss. The patient was a known hypertensive for the last 2 years and was on Lisinopril, Aspirin, and Indapamide. Both his father and grandfather died at the age 84 years of prostatic cancer. His mother had cancer of the esophagus and his maternal aunt had breast cancer in her 70s. Examination of the left upper limb demonstrated a swol- len left arm and dilated subcutaneous veins around the left shoulder. The radial artery pulsations were normal on the left side. Examination of the neck and axilla revealed a 3 3-cm size mobile, non-tender, firm lymph node in the left supraclavicular region and a 2 2-cm size mobile, non- tender, firm lymph node in the axilla. Abdominal examina- tion was unremarkable. Laboratory evaluation revealed a normal full blood count, clotting, liver function test, urea and electrolytes. In keeping with a working diagnosis of axillary vein thrombosis secondary to lymphadenopathy due to lymphoma, a left venogram and CT scan of the neck and chest was done. Venogram demonstrated occlusion of bra- chial vein just distal to the axilla, axillary, and subclavian vein (Fig. 1 A,B). Heparin and warfarin were started on the