Occult colon cancer in a patient with an unexplained episode of pulmonary embolism

The association between venous thromboembolism and cancer has been widely d ocumented and the main factor responsible for cancer-induced venous thrombo embolism is considered mostly linked to a hypercoagulation state induced by the cancer itself. There is no consensus on investigative strategies for o ccult cancer in a patient with a thrombophilic condition. We report a patie nt who manifested an isolated episode of pulmonary embolism without specifi c evident sources of venous thromboembolism. The routine clinical and labor atory work-up to detect an occult cancer did not reveal any malignancy. A h istory of duodenal ulcer in association with a recent slight alteration in bowel habits led us to perform an esophagogastroduodenoscopy which was nega tive for malignancy, and a barium enema followed by colonoscopy, which reve aled the presence of a tumor limited to the large intestine. An unexplained clinically evident hypercoagulation state, even in the presence of mild cl inical symptoms, needs more thorough diagnostic strategies when simple meth ods;of screening for occult cancer are negative.