Asymptomatic renal infarction after left upper lobectomy: Case report

Abstract

Background Renal infarction after pulmonary resection is relatively rare; however, it is associated with severe morbidity. Case presentation An 80-year-old woman without any severe comorbidity or smoking history underwent left upper lobectomy (LUL) concomitant with mediastinal lymph node dissection for lung adenocarcinoma. She did not show fever, flank pain, and/or nausea; however, laboratory data revealed an elevated white blood cell count (WBC) (13,460 cells/mm 3 ) and elevated serum lactate dehydrogenase (LDH) (670 IU/L) and C-reactive protein (CRP) (23.6 mg/dL) levels on the fifth postoperative day. Contrast-enhanced computed tomography from the thorax to the pelvic cavity revealed a partial defect of the right kidney without any indication of infection and no pulmonary vein stump thrombosis. We diagnosed the patient with partial right renal infarction, and heparin (10,000 IU/day) was initiated. Laboratory data showed gradual reduction in the WBC (7700 cells/mm 3 ), as well as in the serum LDH (355 IU/L) and CRP (0.76 mg/dL) levels, 7 days after heparin initiation. Anticoagulation therapy including heparin administration was discontinued because renal function remained, and we observed no pulmonary vein stump thrombosis. Laboratory data remained within normal limits, and the patient was discharged on postoperative day 15. Conclusions LUL is considered a risk factor for this condition, and elevated WBC, as well as serum LDH and CRP levels are useful diagnostic indicators.

Efficacy of direct oral anticoagulant for renal infarction due to pulmonary vein stump thrombosis after left pneumonectomy

“…Since only 1% of RIs found at autopsy are diagnosed antemortem [ 7 ], many of them are overlooked, and the exact number is still unknown. In many instances, the symptoms are nonspecific and may be mistaken for those caused by renal pyelonephritis, renal colic, acute mesenteric events, or urinary tract infections, which can cause delays in diagnosis and treatment [ 5 , 6 ]. Previous studies have reported elevations in white blood cell count, LDH, C-reactive protein, and creatinine in blood investigations, as well as hematuria in urinalysis [ 5 ].…”

“…A thrombus here might develop because of turbulent flow or stasis of blood in the stump [ 1 ]. There have been only 13 reports of RI after surgery for lung cancer (Table 1 ) [ 4 , 5 , 8 – 17 ], including our case, and they included left lung cancer with isolation of the left superior pulmonary vein. In these cases, the median time to RI onset was POD 4 (interquartile range, POD 3–12).…”

“…It is a source of embolism in various organs, including the kidneys and the brain [ 2 – 4 ]. PVST is present in 33% of reported RI after lung resection, and almost all patients receive anticoagulant therapy with heparin, warfarin, or dipyridamole [ 5 ]. However, no standard guidelines exist regarding PVST anticoagulant treatment.…”