Pulmonary Vein Thrombosis: A Recent Systematic Review

Abstract

The pulmonary veins (PVs) are the most proximal source of arterial thromboembolism. Pulmonary vein thrombosis (PVT) is a rare but potentially lethal disease; its incidence is unclear, as most of the literature includes case reports. It most commonly occurs as a complica-tion of malignancy, post lung surgery, or atrial fibrillation and can be idiopathic in some cases. Most patients with PVT are commonly asymptomatic or have nonspecific symptoms such as cough, hemoptysis, and dyspnea from pulmonary edema or infarction. The thrombi are typically detected using a variety of imaging modalities including transesophageal echocardiogram (TEE), computed tomography (CT) scanning, magnetic resonance imaging (MRI), or pulmonary angiog-raphy. Treatment should be determined by the obstructing pathological finding and can include antibiotic therapy, anticoagulation, thrombectomy, and/or pulmonary resection. The delay in diagnosing this medical entity can lead to complications including pulmonary infarction, pulmonary edema, right ventricular failure, allograft failure, and peripheral embolism resulting in limb ischemia, stroke, and renal infarction (RI).

Keywords: pulmonary vein; thrombosis.

Figure 1. The hypothesis of a thrombus in the pulmonary vein stump after lobectomy

In a short PV stump, blood flow may occur because blood flow in the left atrium (LA) spreads through the entire PV stump. In the long PV stump, turbulent flow or stasis of blood may occur because blood flow in the LA does not spread throughout the stump [6].

Figure 2. CT scan of the chest with IV contrast

A thrombus (white arrow) in the left superior pulmonary vein stump after left upper lobectomy [6].

Figure 3. Baseline 2D transesophageal echocardiography

TEE demonstrating mobile echogenic thrombus within right superior pulmonary vein. LA = left atrium; RSPV = right superior pulmonary vein; THROMBUS = pulmonary vein thrombus [36].