Pulmonary Vein Tumor Thrombus With Intracardiac Extension Secondary to Poorly Differentiated Bronchogenic Carcinoma

Abstract

Pulmonary vein thrombosis (PVT) is a rarely encountered disease entity with varied clinical presentations. It has been reported to be associated with underlying lung malignancy in multiple case reports. Diagnosis can be challenging due to nonspecific symptoms on presentation. Herein, we report a 67-year-old male patient with a history of extensive smoking and chronic obstructive pulmonary disease (COPD) who presented with multiple hemoptysis episodes. CT scan of the chest with contrast showed multiple right lower lobe (RLL) lung masses and a thrombus in the inferior pulmonary vein. After various imaging modalities and transthoracic biopsy of the lung mass, the patient was diagnosed with pulmonary vein tumor thrombus secondary to poorly differentiated bronchogenic carcinoma with intracardiac extension. The patient was started on Eliquis for anticoagulation and is currently in the process of beginning chemo/radiation therapy for the underlying malignancy.

Pulmonary vein thrombosis associated with metastatic uterine leiomyosarcoma: a case report

“…In our patient, the diagnosis was made by pulmonary CT angiography. The thrombus was located at the branches of both the right [ 5 – 7 , 9 , 10 , 12 ] and left [ 4 , 8 , 11 ] pulmonary veins. In our patient, thrombosis was observed in the left infero-posterior pulmonary vein.…”

“…Half of the patients were female, and the other half were male. In two cases, PVT was a complication of primary lung cancer (giant cell lung carcinoma [ 4 ] and bronchogenic carcinoma [ 5 ]). The remaining patients had metastatic cancers with different origins.…”

“…The remaining patients had metastatic cancers with different origins. In six cases [ 5 – 7 , 9 , 10 , 12 ], the thrombus was located at the branches of the right pulmonary vein. In the other four cases, including the present case, it was located at the branches of the left pulmonary vein [ 4 , 8 , 11 ].…”

“…[ 7 ] 66/M Small cell lung carcinoma/intestinal mantle cell lymphoma Inferior branch of right pulmonary vein Anticoagulant Died Faiek et al . [ 5 ] 67/M Bronchogenic carcinoma Right inferior pulmonary vein Anticoagulant Improved Tamizifar et al . [ 8 ] 40/F Liposarcoma Left inferior pulmonary vein Anticoagulant Died Bonnet et al .…”

“…Primary lung cancers are the most common malignancies associated with PVT [1]. Leivaditis et al [4] reported giant cell lung carcinoma and Faiek et al [5] reported bronchogenic carcinoma causing PVT. However, metastatic cancers such as osteogenic carcinoma [6], intestinal mantle cell lymphoma [7], liposarcoma [8], choriocarcinoma [9], follicular thyroid carcinoma [10], polycythemia vera [11], and renal cell carcinoma [12] have also been reportedly associated with PVT.…”