pulmonary vein thrombosis (PVT)

see also:

• thrombosis
• thrombophilia
• pulmonary embolism (PE)
• Cureus. 2017 Pulmonary Vein Thrombosis: A Recent Systematic Review

• pulmonary vein thrombosis is a rare and potentially life threatening condition with mortality rate dependent upon the aetiology
• potential for cardiopulmonary complications such as:
  • pulmonary infarction
  • pleural effusion
  • pulmonary oedema
  • right heart failure
  • allograft failure
  • pulmonary gangrene
  • massive haemoptysis
• potential for systemic thrombo-embolic complications such as stroke (CVA), limb ischaemia or renal infarction

• post-procedure:
  • lung transplantation - 15% of transplants, usually in 1st 48hrs, but can occur up to 2yrs
  • lobectomy with resection of the left upper lobe with subsequent thrombus formation in the left upper PV stump
  • radiofrequency catheter ablation (RFCA) for atrial fibrillation causing pulmonary vein stenosis
• sclerosing mediastinitis
• primary or secondary tumors of the lung
  • especially bronchogenic carcinoma
  • metastatic sarcoma, liposarcoma, small cell lung cancer, mantle cell lymphoma of the small intes­tine
• atrial myxoma
• congenital pulmonary venous narrowing
• mitral stenosis with an obstructing left atrial clot
• blunt chest trauma (rare cause)
• sickle cell disease
• large hiatal hernia potentially could be a cause (1 recorded case)

• most are asymptomatic
• some have cough, haemoptysis
• those with pulmonary oedema or infarct develop SOB
• some may present with transient ischaemic attack (TIA) or stroke (CVA)

• CXR may show consolidation or pleural effusion
• pulmonary venous phase of CTPA
• MRI of the chest can distinguish be­tween a bland thrombus and a tumor thrombus in the pulmonary vein
• transesophageal echocardiogram may demonstrate the extension of the thrombus into the atrium

• anticoagulation
  • little evidence to provide clear guidelines but seems a DOAC may be reasonable