Pulmonary vein thrombosis
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- updated 6 Apr 2022:
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Pulmonary vein thrombosis is a rare but potentially serious condition with a number of underlying possible aetiologies.
Clinical presentation
Often the signs and symptoms are non-specific and can range from acute (pulmonary infarction) to more insidious (progressive or recurrent pulmonary oedema). Patients may have dyspnoea, haemoptysis, chest pain, fever, and/or hypoxaemia.
Pathology
Aetiology
Causes include:
intrapulmonary neoplasm: considered most frequent cause 1
as a complication of lung transplantation or lobectomy 6
as a complication of radiofrequency ablation
mitral stenosis with a left atrial clot
hypercoagulable state
idiopathic
Radiographic features
CT
Chronic pulmonary vein stenosis or obstruction may demonstrate9:
interlobular septal thickening and ground glass opacification due to localised pulmonary oedema
enlarged lymph nodes, lymphangiectasis and pleural effusion due to impaired venous drainage
venous collateral pathways - venous varices
thickening of bronchovascular bundles due to bronchovascular ectasis and remodelling of the bronchial arteries and veins
pleural plaques may be seen due to organisation of the fibrinous exudates
interstitial fibrosis may also be seen due to the accumulation of siderophages in the intestersitial spaces
Treatment and prognosis
Anticoagulation use is thought to be doubtful in terms of clinical outcome but may avoid clot development in the left atrium and possibly promote recanalisation of the affected pulmonary vein 3.
See also
-<li>intrapulmonary neoplasm: considered most frequent cause <sup>1</sup>-</li>-<li>as a complication of <a href="/articles/lung-transplant-complications">lung transplantation</a> or <a href="/articles/lobectomy-lung">lobectomy</a> <sup>6</sup>-</li>-<li>as a complication of <a href="/articles/radiofrequency-ablation">radiofrequency ablation</a>-</li>-<li><a href="/articles/fibrosing-mediastinitis">fibrosing mediastinitis</a></li>-<li>-<a href="/articles/mitral-valve-stenosis-1">mitral stenosis</a> with a left atrial clot</li>-<li>-<a href="/articles/hilar-torsion">hilar torsion</a> <sup>3</sup>-</li>-<li>hypercoagulable state</li>-<li>idiopathic</li>- +<li><p>intrapulmonary neoplasm: considered most frequent cause <sup>1</sup></p></li>
- +<li><p>as a complication of <a href="/articles/lung-transplant-complications">lung transplantation</a> or <a href="/articles/lobectomy-lung">lobectomy</a> <sup>6</sup></p></li>
- +<li><p>as a complication of <a href="/articles/radiofrequency-ablation">radiofrequency ablation</a></p></li>
- +<li><p><a href="/articles/fibrosing-mediastinitis">fibrosing mediastinitis</a></p></li>
- +<li><p><a href="/articles/mitral-valve-stenosis-1">mitral stenosis</a> with a left atrial clot</p></li>
- +<li><p><a href="/articles/hilar-torsion">hilar torsion</a> <sup>3</sup></p></li>
- +<li><p>hypercoagulable state</p></li>
- +<li><p>idiopathic</p></li>
- +</ul><h4>Radiographic features</h4><h5>CT</h5><p>Chronic pulmonary vein stenosis or obstruction may demonstrate<sup>9</sup>:</p><ul>
- +<li><p><a href="/articles/interlobular-septal-thickening" title="Interlobular septal thickening">interlobular septal thickening</a> and <a href="/articles/ground-glass-opacification-3" title="Ground glass opacification">ground glass opacification</a> due to localised pulmonary oedema</p></li>
- +<li><p>enlarged lymph nodes, lymphangiectasis and pleural effusion due to impaired venous drainage</p></li>
- +<li><p>venous collateral pathways - venous varices</p></li>
- +<li><p><a href="/articles/thickening-of-bronchovascular-bundles" title="Thickening of bronchovascular bundles">thickening of bronchovascular bundles</a> due to bronchovascular ectasis and remodelling of the bronchial arteries and veins</p></li>
- +<li><p><a href="/articles/pleural-plaque" title="Pleural plaques">pleural plaques</a> may be seen due to organisation of the fibrinous exudates</p></li>
- +<li><p>interstitial fibrosis may also be seen due to the accumulation of siderophages in the intestersitial spaces</p></li>
-<li><a href="/articles/pulmonary-veins">pulmonary vein</a></li>-<li><a href="/articles/pulmonary-vein-atresia">pulmonary vein atresia</a></li>-<li><a href="/articles/pulmonary-vein-stenosis">pulmonary vein stenosis</a></li>- +<li><p><a href="/articles/pulmonary-veins">pulmonary vein</a></p></li>
- +<li><p><a href="/articles/pulmonary-vein-atresia">pulmonary vein atresia</a></p></li>
- +<li><p><a href="/articles/pulmonary-vein-stenosis">pulmonary vein stenosis</a></p></li>
References changed:
- 1. Porres D, Morenza O, Pallisa E, Roque A, Andreu J, Martínez M. Learning from the Pulmonary Veins. Radiographics. 2013;33(4):999-1022. <a href="https://doi.org/10.1148/rg.334125043">doi:10.1148/rg.334125043</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23842969">Pubmed</a>
- 2. Kim N, Roldan C, Shively B. Pulmonary Vein Thrombosis. Chest. 1993;104(2):624-6. <a href="https://doi.org/10.1378/chest.104.2.624">doi:10.1378/chest.104.2.624</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8339662">Pubmed</a>
- 3. Genta P, Ho N, Beyruti R, Takagaki T, Terra-Filho M. Pulmonary Vein Thrombosis After Bilobectomy and Development of Collateral Circulation. Thorax. 2003;58(6):550-1. <a href="https://doi.org/10.1136/thorax.58.6.550">doi:10.1136/thorax.58.6.550</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12775876">Pubmed</a>
- 4. Selvidge S & Gavant M. Idiopathic Pulmonary Vein Thrombosis: Detection by CT and MR Imaging. AJR Am J Roentgenol. 1999;172(6):1639-41. <a href="https://doi.org/10.2214/ajr.172.6.10350306">doi:10.2214/ajr.172.6.10350306</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10350306">Pubmed</a>
- 5. Hovaguimian H, Morris J, Gately H, Floten H. Pulmonary Vein Thrombosis Following Bilobectomy. Chest. 1991;99(6):1515-6. <a href="https://doi.org/10.1378/chest.99.6.1515">doi:10.1378/chest.99.6.1515</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/2036839">Pubmed</a>
- 5. Selvidge S & Gavant M. Idiopathic Pulmonary Vein Thrombosis: Detection by CT and MR Imaging. AJR Am J Roentgenol. 1999;172(6):1639-41. <a href="https://doi.org/10.2214/ajr.172.6.10350306">doi:10.2214/ajr.172.6.10350306</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10350306">Pubmed</a>
- 6. Burri E, Duwe J, Kull C, Glaser C, Maurer C. Pulmonary Vein Thrombosis After Lower Lobectomy of the Left Lung. J Cardiovasc Surg (Torino). 2006;47(5):609-12. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17033613">Pubmed</a>
- 7. Alexander G, Reddi A, Reddy D. Idiopathic Pulmonary Vein Thrombosis: A Rare Cause of Massive Hemoptysis. Ann Thorac Surg. 2009;88(1):281-3. <a href="https://doi.org/10.1016/j.athoracsur.2008.09.061">doi:10.1016/j.athoracsur.2008.09.061</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19559247">Pubmed</a>
- 8. Chaaya G & Vishnubhotla P. Pulmonary Vein Thrombosis: A Recent Systematic Review. Cureus. 2017;9(1):e993. <a href="https://doi.org/10.7759/cureus.993">doi:10.7759/cureus.993</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28265529">Pubmed</a>
- 9. Braun S, Platzek I, Zöphel K et al. Haemoptysis Due to Pulmonary Venous Stenosis. Eur Respir Rev. 2014;23(132):170-9. <a href="https://doi.org/10.1183/09059180.00003713">doi:10.1183/09059180.00003713</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24881072">Pubmed</a>
- 1. Porres DV, Morenza OP, Pallisa E et-al. Learning from the pulmonary veins. Radiographics. 2013;33 (4): 999-1022. <a href="http://dx.doi.org/10.1148/rg.334125043">doi:10.1148/rg.334125043</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23842969">Pubmed citation</a><span class="auto"></span>
- 2. Kim N. Pulmonary vein thrombosis. Chest. 01;104 (2): 624-626. <a href="http://dx.doi.org/10.1378/chest.104.2.624">doi:10.1378/chest.104.2.624</a><span class="auto"></span>
- 3. Genta PR, Ho N, Beyruti R et-al. Pulmonary vein thrombosis after bilobectomy and development of collateral circulation. Thorax. 2003;58 (6): 550-1. <a href="http://dx.doi.org/10.1136/thorax.58.6.550">doi:10.1136/thorax.58.6.550</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746717">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12775876">Pubmed citation</a><span class="auto"></span>
- 4. Selvidge SD, Gavant ML. Idiopathic pulmonary vein thrombosis: detection by CT and MR imaging. AJR Am J Roentgenol. 1999;172 (6): 1639-41. <a href="http://dx.doi.org/10.2214/ajr.172.6.10350306">doi:10.2214/ajr.172.6.10350306</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10350306">Pubmed citation</a><span class="auto"></span>
- 5. Hovaguimian H, Morris JF, Gately HL et-al. Pulmonary vein thrombosis following bilobectomy. Chest. 1991;99 (6): 1515-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2036839">Pubmed citation</a><span class="auto"></span>
- 5. Selvidge SD, Gavant ML. Idiopathic pulmonary vein thrombosis: detection by CT and MR imaging. AJR Am J Roentgenol. 1999;172 (6): 1639-41. <a href="http://dx.doi.org/10.2214/ajr.172.6.10350306">doi:10.2214/ajr.172.6.10350306</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10350306">Pubmed citation</a><span class="auto"></span>
- 6. Burri E, Duwe J, Kull C et-al. Pulmonary vein thrombosis after lower lobectomy of the left lung. J Cardiovasc Surg (Torino). 2006;47 (5): 609-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17033613">Pubmed citation</a><span class="auto"></span>
- 7. Alexander GR, Reddi A, Reddy D. Idiopathic pulmonary vein thrombosis: a rare cause of massive hemoptysis. Ann. Thorac. Surg. 2009;88 (1): 281-3. <a href="http://dx.doi.org/10.1016/j.athoracsur.2008.09.061">doi:10.1016/j.athoracsur.2008.09.061</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19559247">Pubmed citation</a><span class="auto"></span>
- 8. Chaaya G, Vishnubhotla P. Pulmonary Vein Thrombosis: A Recent Systematic Review. (2017) Cureus. 9 (1): e993. <a href="https://doi.org/10.7759/cureus.993">doi:10.7759/cureus.993</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28265529">Pubmed</a> <span class="ref_v4"></span>
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