Transesophageal Echocardiographically-Confirmed Pulmonary Vein Thrombosis in Association with Posterior Circulation Infarction

Abstract

Pulmonary venous thromboembolism has only been identified as a cause of stroke with pulmonary arteriovenous malformations/fistulae, pulmonary neoplasia, transplantation or lobectomy, and following percutaneous radiofrequency ablation of pulmonary vein ostia in patients with atrial fibrillation. A 59-year-old man presented with a posterior circulation ischemic stroke. 'Unheralded' pulmonary vein thrombosis was identified on transesophageal echocardiography as the likely etiology. He had no further cerebrovascular events after intensifying antithrombotic therapy. Twenty-eight months after initial presentation, he was diagnosed with metastatic pancreatic adenocarcinoma and died 3 months later. This report illustrates the importance of doing transesophageal echocardiography in presumed 'cardioembolic' stroke, and that potential 'pulmonary venous thromboembolic' stroke may occur in patients without traditional risk factors for venous thromboembolism. Consideration should be given to screening such patients for occult malignancy.

Fig. 1

Axial MR diffusion weighted image showing acute right pontine infarction (arrow).

Fig. 2

Baseline 2D TEE demonstrating mobile echogenic thrombus within right superior pulmonary vein. RSPV = right superior pulmonary vein; LA = left atrium; THROMBUS = pulmonary vein thrombus.

Fig. 3

Repeat TEE image 8 days later demonstrating partial resolution of the PVT. RSPV = right superior pulmonary vein; LA = left atrium; THROMBUS = pulmonary vein thrombus.