Idiopathic pulmonary vein thrombosis complicated with old myocardial infarction detected by multidetector row computed tomography

Abstract

Pulmonary vein thrombosis is rarely detected in patients with cancer, lung lobectomy, trauma and so on. We report the case of idiopathic pulmonary vein thrombosis complicated with coronary heart disease. A-57-year-old man with suspected coronary heart disease underwent computed tomography coronary angiography. He did not show any sign of malignancy in lung or other organs. Multi-detector row computed tomography demonstrated 3-dimensional images for the thrombi in bilateral lower pulmonary veins besides an old anterior myocardial infarction. Previously, few reports have described the detection of pulmonary vein thrombosis, however, multi-detector row computed tomography was thought to be useful for detecting and evaluating pulmonary vein thrombosis.

Keywords: Idiopathic pulmonary vein thrombosis; Multidetector row computed tomography; Old myocardial infarction.

Figure 1

(A) Axial image of pulmonary vein. The image demonstrated thrombi in both lower pulmonary veins. (B) Posterio-anterior view of volume rendering image of pulmonary vein. The image shows thrombi in some branches of both lower pulmonary veins.

Figure 2

(A) Curved multiplanar reformation image of left lower pulmonary vein. The image shows long thrombus and occlusion of left lower pulmonary vein. (B) Curved multiplanar reformation image of right lower pulmonary vein. The image shows long thrombus and occlusion of the right lower pulmonary vein.

Figure 3

(A) Curved multiplanar reformation image of left anterior descending coronary artery. CT image showed an occlusion with remarkable calcification at the proximal portion of left anterior descending artery, showing significantly lower CT attenuation compared to the attenuation of proximal or distal portion (an arrow). (B) Curved multiplanar reformation image of left circumflex coronary artery. The middle portion of left circumflex artery was unevaluable because of massive calcification, but there was no significant stenosis at the proximal and distal portion. (C) Curved multiplanar reformation image of right coronary artery. Right coronary artery was also affected by remarkable calcification, but did not show significant stenosis. (D) Right anterior oblique image of left ventricle. Subendocardium of anterior wall of left ventricle demonstrated slightly lower attenuation without thinning, suggesting subendocardial old myocardial infarction.