Pulmonary Vein Thrombosis: A Case Report and Literature Review

1Loyola University Medical Center, Maywood, IL

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 325

Case Presentation:

A 76‐year‐old man with scoliosis and hypertension presented with acute onset of dyspnea associated with cough and chest tightness. Physical exam was remarkable for a temperature of 102.3°F, RR of 25, and oxygen saturation of 95% on a 6‐L nasal cannula. Pulmonary exam demonstrated bilateral expiratory wheezing. Chest x‐ray found no infiltrates or edema. Electrocardiogram showed no ischemic findings. Laboratory analysis found no leukocytosis, anemia, or elevation in troponin and brain natriuretic peptide. Blood cultures were negative. CT pulmonary embolus protocol showed no pulmonary artery emboli but found pulmonary vein thrombosis (PVT). Marked scoliosis and deformity of the pulmonary veins was noted as well as narrowing and deformity of the hila and bronchi. Anticoagulation was started with intraenous heparin. Further workup with transesophageal echocardiography (TEE) did not visualize any PVT. Bronchoscopy revealed normal airways without evidence of extrinsic compression, masses, or airway edema. The patient initially was treated with Tamiflu, ceftriaxone, azithromycin, and intravenous solume‐drol for a suspected upper respiratory infection with reactive airways. There was rapid clinical improvement within 24 hours with resolution of symptoms and fevers. Anticoagulation was recommended with a target INR of 2–3 as well as a follow‐up CT in 3 months.

FIGURE . The arrow shows a linear filling defect in the right inferior pulmonary vein.

Discussion:

PVT is a rare diagnosis most often associated with lung transplantation, lung carcinoma, and lobectomy. Outside these conditions, approximately 12 documented case reports of PVT have been described. These “idiopathic” case reports are associated with a variety of heterogeneous conditions including occult malignancy, blunt chest trauma, sickle cell anemia, pulmonary fibrosis, and radiofrequency ablation. Symptoms are nonspecific, with dyspnea, cough, chest pain, and hemoptysis. Most cases of PVT are diagnosed incidentally by CT or TEE in the hospitalized patient undergoing workup for an acute cardiovascular or pulmonary process. TEE has been studied to diagnose PVT in post– lung transplant patients. Complications of PVT include: pulmonary infarction, allograft failure, ischemic stroke, and limb ischemia. PVT has been successfully treated with thrombectomy and anticoagulation. PVT in association with scoliosis has not been previously described. We postulate that the deformity of the right pulmonary vein by the patient's scoliosis contributed to endothelial damage and transient stasis, which are well‐known risk factors for venous thromboembolism.

Conclusions:

The purpose of this case is to describe a rare presentation of PVT and to review the available literature.

Disclosures:

H. Lee ‐ none; A. Wanless ‐ none

To cite this abstract:

Lee H, Wanless A. Pulmonary Vein Thrombosis: A Case Report and Literature Review. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 325. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/pulmonary-vein-thrombosis-a-case-report-and-literature-review/. Accessed May 22, 2019.

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