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Case Reports
. 2014 Jan 6:9:5.
doi: 10.1186/1749-8090-9-5.

Left upper lobectomy can be a risk factor for thrombosis in the pulmonary vein stump

Kazuto Ohtaka  1 , Yasuhiro Hida, Kichizo Kaga, Yasuhiro Takahashi, Hiroshi Kawase, Satoshi Hayama, Tatsunosuke Ichimura, Naoto Senmaru, Naotake Honma, Yoshiro Matsui
Affiliations
Case Reports

Left upper lobectomy can be a risk factor for thrombosis in the pulmonary vein stump

Kazuto Ohtaka et al. J Cardiothorac Surg. .

Abstract

Background: Thrombosis in the left upper pulmonary vein stump after left upper lobectomy is a very rare but important complication because it occurs in the systemic circulation system. We previously made the first ever report on the frequency and risk factors of thrombosis in the pulmonary vein stump after lobectomy. In this study, we conducted an investigation in a different hospital to determine whether this was a common complication.

Methods: From 2008 to 2012, 151 patients who underwent lobectomy and following enhanced CT within 2 years after the operation were studied. Postoperative contrast-enhanced CT imaging was retrospectively checked.

Results: We found thrombosis in the pulmonary vein stump in 5 of the 151 patients (3.3%). All 5 patients underwent left upper lobectomy (17.9% of the patients who underwent left upper lobectomy). These 5 patients did not have infarction of any vital organ. The thrombus was disappeared several months later on contrast-enhanced CT in 3 patients and followed in 2 patients. On univariate analysis, there was a significant difference only in the operative procedure (p<0.001).

Conclusions: Thrombosis in the pulmonary vein stump occurred with high frequency in patients who underwent left upper lobectomy. Because the frequency of thrombosis in this study was the same as in our previous report, this might be a common complication.

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Figures

Figure 1
Figure 1
A thrombus in the left superior pulmonary vein stump after left upper lobectomy. Contrast-enhanced CT on a 78 year-old male to check for other diseases on postoperative day 22 shows a thrombus in the LSPV stump.
Figure 2
Figure 2
A thrombus in the left superior pulmonary vein stump after left upper lobectomy. Contrast-enhanced CT on a 66 year-old male for follow-up 7 months postoperatively shows a thrombus in the LSPV stump. This thrombus was not detected at that time.
Figure 3
Figure 3
The hypothesis of a thrombus in the pulmonary vein stump after lobectomy. In a short PV stump, blood flow may occur because that in the left atrium spreads throughout the stump. In the long PV stump, turbulent flow or stasis of blood may occur because blood flow in the left atrium does not spread throughout the stump.
See this image and copyright information in PMC

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