pulmv_thrombosis
Table of Contents
pulmonary vein thrombosis (PVT)
see also:
Introduction
- 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
Aetiology
- 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)
Clinical features
- 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)
Diagnosis
- 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
Mx
- anticoagulation
- little evidence to provide clear guidelines but seems a DOAC may be reasonable
pulmv_thrombosis.txt · Last modified: 2021/06/03 07:18 by gary1