Thrombus Formation in the Pulmonary Vein Stump after Left Upper Lobectomy: A Report of Four Cases

Abstract

Left upper lobectomy may be followed by complications such as thrombus formation in a stump of the left superior pulmonary vein (LSPV), which may cause systemic embolization. We have encountered four such cases, which account for 3.4% of all left upper lobectomies performed at our institution. Right renal infarction was observed in one of these four cases; the remaining cases were asymptomatic, with the thrombus incidentally detected by enhanced computed tomography (CT). The postoperative duration for the detection of the thrombus varied from 4 days to 24 months. Even in a case in which the superior pulmonary vein (PV) was divided by posterolateral thoracotomy, CT showed that the stump was long enough intrapericardially for thrombus formation. Anticoagulant therapy was administered in all the cases, resulting in dissipation of the thrombus. Therefore, when a thrombus is detected in a pulmonary stump, an anticoagulant should be administered.

Left superior pulmonary venous thrombosis complicated with splenic infarction after video-assisted thoracoscopic left upper lobectomy

“…To our knowledge, only 7 patients have had radiographically described pulmonary venous thrombosis leading to embolic events after lobectomy [1][2][3][4][5]. Moreover, two reports also showed 5 asymptomatic patients with only LSPV thrombus and no systemic organ infarction [4,5]. Interestingly, all cases underwent left upper lobectomy and LSPV thrombus was described.…”

“…Pulmonary venous thrombosis after lung surgery has also been reported in the early postoperative period [3,4], and this condition is rare, but a serious complication, with no standard guideline for management, that may lead to systemic organ infarction. To our knowledge, only 7 patients have had radiographically described pulmonary venous thrombosis leading to embolic events after lobectomy [1][2][3][4][5]. Moreover, two reports also showed 5 asymptomatic patients with only LSPV thrombus and no systemic organ infarction [4,5].…”

“…3B). Previous reports demonstrated favorable outcome of disappearance of thrombus after several months of warfarin therapy in eight cases [3][4][5] and only two cases of large thrombus, one of which developed from the inside of the LSPV into the left atrial cavity, needed surgical treatment [1,2]. Regarding the use of the non-vitamin K antagonist oral anticoagulants in this setting, only one case report demonstrated the efficacy of dabigatran, a direct thrombin inhibitor, to floating thrombus in the left upper PV [10].…”

“…In some previous cases, pulmonary venous thrombosis after lung surgery has been reported in the early postoperative period [3,4]. However, others reported various detection times from postoperative day 2-24 months after surgery [1][2][3][4][5].…”

“…Only a few reports have radiographically described this lethal complication after open lung [1][2][3][4] or VATS lobectomy [5]. Pulmonary venous thrombosis may lead to systemic organ and peripheral artery infarction such as in the brain, kidneys, spleen, and peripheral superior and inferior limbs.…”