Case Reports

Pulmonary Vein Thrombosis Associated With Metastatic Carcinoma

Fed Pract. 2014 December;31(12):26-28

References

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Newer CT techniques have made identifying PVT possible in a similar manner to which pulmonary arterial emboli are detected by using the pulmonary venous phase of a contrast CT of the chest.⁵ Echocardiography may demonstrate the extension of the thrombus into the atrium; a transesophageal echocardiogram would be preferable over a transthoracic echocardiogram. Magnetic resonance imaging of the chest is another useful modality for diagnosis, because it is able to distinguish between a bland thrombus and a tumor thrombus in the pulmonary vein.¹⁵

Treatment of PVT depends on the overall clinical condition of the patient. Irrespective of the etiology, a review of the literature does not indicate the preferred duration of anticoagulation or preference for modality of anticoagulation between oral vitamin K antagonists or heparin—low molecular or unfractionated.^1,3-6Patients who develop PVT following malignancy are usually anticoagulated with therapy for the cancer. The treatment of PVT in the setting of lung transplant is more challenging and includes systemic heparinization, thrombolytics, and surgical thrombectomy.^3,11,16 The majority of the literature includes case reports with varying morbidity and mortality, depending on the etiology. Ninety-day mortality of 38% was reported following lung transplant.³

CONCLUSION

Pulmonary vein thrombosis presents in a nonspecific manner. The diagnosis is now more readily made with the advent of a variety of diagnostic modalities, especially with transesophageal echocardiography, which may be performed at the bedside in the intensive care unit. The treatment remains challenging with mortality dependent on the etiology. A diagnosis of PVT needs to be considered in patients with appropriate risk factors. A high index of suspicion will enable the diagnosis in the proper clinical scenario.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

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