Screening for Occult Malignancy in Patients With Idiopathic Venous Thromboembolism

Inclusion criteria

• Patients with a new diagnosis of unprovoked proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) will be eligible to participate into the study:

• Unprovoked VTE is defined as the absence of any of the following predisposing factors:

• known active cancer;
• recent (less than 3 months) paralysis, paresis or plaster immobilization of the lower extremities;
• recently bedridden for period of 3 or more days, or major surgery, within the previous 12 weeks requiring general or regional anaesthesia;
• previous unprovoked VTE;
• known thrombophilia (hereditary or acquired)
• Proximal DVT is defined as a non-compressibility of any vein segment from the common femoral vein to the trifurcation of the popliteal vein or a persistent intra-luminal filling defect of the iliac, common femoral, superficial femoral or popliteal veins on contrast venography.
• Pulmonary embolism is defined as:

• patients with a high/intermediate pre-test probability (Wells' model > 4) + high probability V/Q scan;
• positive pulmonary angiogram; or
• spiral CT demonstrating intraluminal filling defect in a vessel larger than a segmental artery

Exclusion criteria

Patients will be excluded from the study if they have any of the following criteria:

• Age < 18 years-old;
• Refusal or inability to provide informed consent;
• Greater than 21 days post diagnosis of idiopathic VTE
• Index VTE event of UEDVT or unusual site DVT
• Diagnosis of SSPE in the absence of above or below knee DVT
• Allergy to contrast media;
• Creatinine clearance < 60 ml/min;
• Claustrophobia or agoraphobia;
• Weight > 130 kg;
• Diagnosis of ulcerative colitis; and
• Diagnosis of glaucoma
• Current pregnancy