Idiopathic pulmonary vein thrombosis treated with apixaban

Abstract

Pulmonary vein thrombosis (PVT) is a rare clinical finding that is potentially fatal and with an unknown incidence rate as known cases exist predominantly in case reports. We present the case of a 58-year-old female who reported sudden onset of chest pain, shortness of breath, and dyspnoea on exertion. A computed tomography (CT) pulmonary angiogram was negative for evidence of pulmonary embolism; however, it did demonstrate the evidence of thrombosis of the right lower lobe segmental pulmonary vein. She had no identifiable aetiologies for her PVT; therefore, she was diagnosed with idiopathic PVT and was treated successfully with apixaban. This case represents the 14th incidence of idiopathic PVT in the current body of medical literature and the first case of successful treatment with apixaban.

Idiopathic bilateral pulmonary vein thrombosis

“…The role of antibiotics in treatment is limited to lobectomy patients with lung infarction due to a superimposed risk of infection [ 10 , 13 ] . Our decision to treat our patient with apixaban was guided by the only other reported case of bilateral PVT [ 1 ] . Prognosis depends on the clot burden and baseline cardiopulmonary reserve; our patient improved progressively with anticoagulation and was discharged with close outpatient follow-up.…”

“…Pulmonary vein thrombosis (PVT) presents substantial challenges in diagnosis and treatment owing to its extreme rarity and potential for fatality. PVT has previously been reported in patients with lung cancer, sickle cell disease, atrial fibrillation, and other malignancies as well as in patients who have undergone lobectomies and lung transplants [ 1 , 2 ] . Because there are so few cases described in the literature, PVT is under-recognised and poorly understood.…”

“…Because there are so few cases described in the literature, PVT is under-recognised and poorly understood. To date, idiopathic PVT has been reported in fewer than 15 patients, with only one of these cases being bilateral PVT [ 1 , 3 ] . We report the second documented case of idiopathic bilateral PVT and discuss how contrast imaging may identify additional cases that may be otherwise overlooked.…”

Successful Stenting for Pulmonary Vein Thrombosis Complicating Pulmonary Vein Stenosis Following Atrial Fibrillation Ablation: A Case Report

“…The management of PVT is not uniform and therapeutic options range from anticoagulation or thrombolytic therapy to surgical thrombectomy and anastomotic revision. [4,9,10] On account of low pressure in PV, PV thrombi are more likely adherent to the vein wall than systemic vein thrombi. A more conservative approach has been advised in the presence of a small thrombus with mild acceleration of blood flow velocity at the site of the thrombus.…”

Pulmonary Vein Thrombosis and Pulmonary Embolus in a Pregnant Patient: A Case Report

“…It is also seen in patients with hematologic disorders such as sickle cell disease or primary lung malignancies [ 1 ]. Idiopathic cases of PVT are extremely rare and limited to case reports [ 3 ]. The presentation of PVT is often nonspecific and may include symptoms such as a cough, dyspnea, and pleuritic chest pain [ 1 , 2 ].…”