Pulmonary venous thrombosis of traumatic origin as cause of bilobar infarction

Abstract

Background: Penetrating chest trauma that is associated with pulmonary injuries can trigger different sequelae, the most frequent being the presence of contusions or pulmonary lacerations that are accompanied by hemopneumothorax.

Materials and methods: Description of a clinical case of interest and review of the literature on the topic.

Results: In this study, we present an unusual consequence of this type of trauma, a pulmonary infarction secondary to an extensive pulmonary venous thrombosis stemming from a firearm injury. This finding associated with lung tissue necrosis led to the need for right upper pulmonary bilobectomy.

Conclusions: The aim of this study is to understand this unusual form of presentation of pulmonary trauma, understand the pathophysiology that triggers lung injury, review the medical literature on the subject, and expand the general knowledge on this topic.

Study type: Therapeutic/care management.

Keywords: Case report; Lung injury; Pulmonary infarction; Pulmonary surgical procedures; Venous thrombosis.

Image 1

Venous thrombosis of the right superior pulmonary vein. A: Immediate post-trauma image. B: Postoperative image of right posterolateral thoracotomy for damage control. Coronal reconstruction of thoracic angiotomography in maximum intensity projections (MIP) in venous phase where it is observed in (A) immediate post-trauma, firearm projectile (red arrow) in the paraesophageal region adjacent to the left atrium and right pulmonary veins and superior pulmonary vein right (yellow arrow) permeable, to which the middle and upper right lobe drain; and in (B) postoperative thoracotomy shows obliteration of the right superior pulmonary vein (yellow arrow) and consolidation of the middle and upper right lobe that confirms pulmonary infarction secondary to venous obstruction. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Image 2

Right superior pulmonary artery thrombosis. A: Immediate post-trauma image. B: Postoperative image of right posterolateral thoracotomy for damage control. Coronal reconstruction of thoracic angiotomography in maximum intensity projections (MIP) in the arterial phase where it is observed in (A) immediate post-trauma, permeable artery for the right upper lobe (yellow arrow) and in (B) post-thoracotomy absence of superior pulmonary artery opacification. Right (yellow arrow) due to thrombosis associated with right upper lobe consolidation due to pulmonary infarction. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)