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A leiomyosarcoma was detected in the region of the left iliac vein in a 37-year-old male patient who had experienced intermittent swelling of the left leg for a period of 3 months prior to admission. The results of the diagnostic imaging procedures carried out (ultrasonography, CT scan, phlebography) all pointed to a thrombus affecting the iliac vein. None of the other diagnostic procedures employed provided any evidence of a malignant disease. The definitive diagnosis was made only on the basis of the histological workup of the material obtained during surgery. The patient died 22 months after establishment of the initial diagnosis with hepatic, pulmonary, renal, and splenic metastatic disease having developed in the meantime. Treatment with chemotherapy and hyperthermia failed to prevent this fatal outcome. This case shows that, in the presence of atypically located “thrombi,” differential diagnostic considerations prior to thrombolytic treatment and surgery should include a tumor, particularly when previous thrombolytic treatment has proved ineffective.

Intraarterial and intravenous infusion of prostaglandin E1 (PGE1) is established treatment for severe peripheral arterial occlusive disease, particularly in Europe and Japan. In this critical appraisal, experimental and clinical studies are reviewed, with special emphasis on cardiopulmonary effects and drug safety. The pulmonary data all indicate dose-dependent dilation of the pulmonary vessels with a reduction in pulmonary resistance. The known hemodynamic effects of PGE1 on the heart include an increase in stroke volume, cardiac index, and left ventricular ejection fraction, and a reduction in left ventricular filling pressure. Analysis of clinical trials shows a low rate of adverse effects, in particular a low incidence of cardiopulmonary side effects. If the recommendations for high-risk patients are observed, PGE1 is both an efficacious and safe therapeutic principle.

In 318 patients (155 men, 163 women) with an average age of 58.8 years (range 16-97 years), a retrospective study was carried out to determine the incidence of occult malignancies in patients with deep venous thrombosis affecting the pelvis and lower limb, confirmed by phlebography or duplex ultrasonography. It was found that, overall, 7.5% of all patients had occult malignant diseases, the most common being bronchial carcinoma (16%), colonic and renal carcinomas (12% each), and prostatic and pancreatic carcinoma (8% each). Of the patients with occult malignancy, 88% were older than 55 years. This fact shows that acute phlebothromboses may be a paraneoplastic early syndrome more often than was previously thought, and that patients older than 50 should always be screened for the presence of a tumor.