Pulmonary Vein Thrombosis: A Rare Entity

Abstract

INTRODUCTION: Idiopathic pulmonary vein thrombosis (PVT) is rare. Although it is a potentially life threatening condition, it is easy to misdiagnose because of the non-specific symptoms. CASE PRESENTATION: A 48-year-old man with diabetes mellitus, hypertension, and pancreatic arteriovenous malformations presented after an episode of syncope. Patient denied any symptoms of cough, dyspnea, hemoptysis and pleuritic chest pain. Initial evaluation revealed tachycardia and orthostatic hypotension. He was given intravenous fluid resuscitation. On the second day, his orthostatic hypotension resolved, but the tachycardia persisted. His heart rhythm remained sinus with rate between 120-140/minute. A week later, for the persistence of tachycardia, a computed tomographic angiogram (CTA) of the chest was performed for the suspected pulmonary embolism. It revealed thrombosis of the left inferior pulmonary vein with associated lung parenchymal changes suggesting venous infarct (Figure 1). Anticoagulation with intravenous unfractionated heparin was begun. One week later, a second CTA, showed complete resolution of the pulmonary vein thrombus and resolution of the associated parenchymal changes (Figure 2). The tachycardia resolved, and he was discharged home on anticoagulation therapy with oral warfarin. Evaluation for hypercoagulable state was negative. DISCUSSION: Idiopathic pulmonary vein thrombosis is difficult to diagnose clinically, but it can lead to potentially life threatening complications. Secondary causes of PVT include lung cancer, lung transplantation, left atrial thrombus, and pulmonary lobectomy. PVT can present as pulmonary infarction with cough, dyspnea, pleuritic chest pain and hemoptysis or, in a more insidious manner, as progressive or recurrent pulmonary edema. PVT occurs in approximately 15% of the post lung transplant patients, most frequently at the anastomotic site, and can lead to early postoperative allograft failure. Complications of PVT include systemic embolization. CONCLUSION(S): Idiopathic pulmonary vein thrombosis has been only rarely reported. This case adds to current information by showing its potentially rapid resolution (within a week) with anticoagulation.