정맥 괴저로 나타난 췌장암에 동반된 반복적 이동성 정맥염
Venous gangrene and migratory thrombophlebitis associated with pancreatic carcinoma
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초록
췌장암에서 혈전증의 발생은 비교적 흔하게 발생하며, 치료 경과에 좋지 않은 영향을 끼친다. 특히 악성 종양과 연관되어 발생한 정맥 괴저는 매우 드물게 발생하며 항 응고제의 사용에도 불구하고 나쁜 예후를 보인다. 췌장암에 동반되어 이동성 심부 정맥 혈전증이 반복되어 발생하고, 적극적인 항 응고제의 사용에도 불구하고 악화되어 정맥 괴저로 나타난 증례 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
It is a common belief that pancreatic carcinoma has an inherent and unique ability to induce hypercoagulable diathesis that leads to clinically significant thrombosis. The reported incidences of disease range from 17% to 57%. Thromboembolic disease is causally associated with an intrinsic hypercoagulable state. Pancreatic cancer cells activate platelets and these express several procoagulant factors, including tissue factor and thrombin. There are a variety of clinical presentations, include deep vein thrombosis, migratory thrombophlebitis, pulmonary embolism, disseminated intravascular coagulation, portal or superior mesenteric vein thrombosis, and extremity ischemia. Venous gangrene is a very unusual and severe form of venous thrombosis of an extremity, and this hasn't yet been reported in Korea. We report here on a case with repeated deep vein thrombosis that was associated with pancreatic carcinoma. Despite of aggressive treatment with low molecular heparin and oral anticoagulant warfarin, the repeated thrombosis was aggravated to venous gangrene of the lower extremity.(Korean J Med 72:226-230, 2007)
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