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 complica­tion 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 angiog­raphy. 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).

Medical image of the month: idiopathic right lower lobe pulmonary vein thrombus

“…Pulmonary vein thrombosis is a rare disease but can be fatal, usually patient presents with non-specific symptoms such as cough and shortness of breath (1). The etiology in most of cases is hypercoagulable disorders, malignancies, atrial fibrillation, post lung operations such as lobectomy and lung transplantation, or could be idiopathic as in our patient.…”

Pulmonary vein thrombosis associated with metastatic ovarian cancer

“…PVT has most commonly been associated with malignancy (primary or metastatic lung tumors), pulmonary surgery or radiofrequency ablation for atrial fibrillation. Though less common, PVT may also occur in patients with arteriovenous malformation, atrial myxoma, blunt trauma, and mitral stenosis [1,2,5,6]. In addition, PVT has also been reported in a patient with sickle cell anemia and in a patient with a large hiatal hernia [7,8].…”

“…Patients with PVT are often asymptomatic, or they may present with nonspecific findings including pleuritic chest pain, shortness of breath, coughing, and hemoptysis. Thus, its diagnosis is often challenging and cannot be made on clinical grounds alone [1,2,7]. Besides, there is no gold standard method for the diagnosis of PVT.…”

“…A combination of diagnostic modalities such as computed tomography pulmonary angiography (CTPA), transesophageal echocardiogram (TEE), transthoracic echocardiogram (TTE), and magnetic resonance imaging (MRI) may be required for the diagnosis. Treatment may vary depending on the etiology, but anticoagulation is recommended in all cases unless there is an active bleeding [1,2]. We present an incidentally detected PVT in a young patient with metastatic ovarian cancer.…”

“…Although it is a life-threatening condition, it may easily be misdiagnosed given its nonspecific clinical presentations. Because the medical literature on the disease is mostly limited to case reports, its actual incidence remains unknown [1]. Although idiopathic cases have been reported in the literature, it often develops as a complication of pulmonary surgery or malignancy [2][3][4].…”