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(1) Background and Objectives: Venous thromboembolism (VTE) is strongly associated with cancer, and may be the first event revealing occult neoplasia. Nonetheless, the reasonable extent of the etiological assessment after an unprovoked VTE event remains debated. The main objective of this study was to evaluate the incidence of occult neoplasia one year after an episode of VTE, in consecutively hospitalized patients for VTE from the REMOTEV registry. The secondary objectives were to assess the performance of the various tests used for occult cancer screening in a real-life setting and analyze the risk factors associated with the discovery of cancer and the 1-year prognosis. (2) Methods: REMOTEV is a prospective, non-interventional cohort study of patients with acute VTE. Patients included in the registry from 23 October 2013 to 28 July 2018 were analyzed after a follow-up of 12 months. Cancer detection was performed according to local practices and consisted of a limited strategy to which an abdominal ultrasound was added. In the presence of suggestive clinical manifestations, further examinations were performed on an individual basis. (3) Results: A total of 993 patients were included in the study. At 1 year, the incidence of newly diagnosed cancer was low (5.3%). Half of the detected cancers were metastatic at discovery (51%) and had a poor global prognosis (32% of mortality at 1 year). Admission pulmonary CT scans as well as (thoracic)-abdomino-pelvic CT scans (when performed) were responsible for the majority of detected cancers. Age over 65 years and the concomitant presence of an unusual site and lower-limb deep vein thrombosis were the only factors associated with occult neoplasia in this cohort. After 1-year FU, mortality was higher in cancer patients (HR 6.0 (CI 95% 3.5−10.3, p < 0.0001)), and cancer evolution was the leading cause of death in the cancer group. (4) Conclusions: In REMOTEV, VTE-revealed occult cancer prevalence was low, but similar to recent reports and associated with higher age, multiple thrombotic sites and worse prognosis.
A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications. Le Corbusier would later describe these as my guide, my choice and as his time-honored ideas, ingrained and deep-rooted in the intellect, like entries from a catechism.
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Occult Vertebral Osteomyelitis, a Diagnostic Conundrum
Brijesh Patel, Adam Forman, Vilma Drelichman, Michael MarshallAbstract
Vertebral osteomyelitis is a well-known but uncommon condition. Typical presenting features include fever, back pain with local tenderness and neurologic symptoms. In absence of these typical findings, vertebral osteomyelitis can be difficult to diagnose. Staphylococcus species are the most common causes. In most cases, inflammatory markers are elevated. Blood cultures can be very useful to identify the culprit organism(s). Though various imaging modalities are available, an MRI is considered gold standard for the diagnosis. Our patient presents with non-specific abdominal pain that masqueraded vertebral osteomyelitis leading to paralysis.
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