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A long and narrow pulmonary vein thrombus attached to the wall of a pulmonary vein.

ABSTRACT: Pulmonary vein thrombosis (PVT) is often not diagnosed because PVT has subtle symptoms and PVT is believed to be rare. The mechanism for the formation of PVT is unclear. In this case, I describe a small thrombus in a small branch of a pulmonary vein draining into a larger vein, the right lower pulmonary vein (RLPV). The patient was a 70-year-old male with angina pectoris, and he presented with chest pain. He had no symptoms of cerebral infarction. He previously had been treated with percutaneous coronary intervention and had four stents in the coronary arteries. A 64-slice multidetector computed tomography (64-MDCT) scan was performed to evaluation for in-stent restenosis. A thrombus in the RLPV was shown in axial and sagittal images as a defect in contrast enhancement, representing a small thrombus in a small branch of a pulmonary vein draining into the RLPV. The 64-MDCT scan depicted them well. The effects of PVT are unknown, and more studies are needed.

SUBMITTER: Takeuchi H

PROVIDER: S-EPMC5497230 | biostudies-other | 2015 Jun

REPOSITORIES: biostudies-other

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Project description:BackgroundThe objective of this study is to examine factors associated with thrombus extension after early experience with mechanochemical ablation, which combines mechanical damage to the venous endothelium with infusion of a sclerosant.MethodsA retrospective review was performed of patients who underwent mechanochemical ablation to treat saphenous vein insufficiency in the thigh including the saphenofemoral junction. Data abstracted included patient demographics, procedural details, and postprocedural outcomes. Thrombus extension was determined by postprocedural duplex ultrasound and classified as flush closure with the femoral vein and any extension of thrombus into the femoral vein.ResultsSeventy-three patients met inclusion criteria. The mean age of the population was 60, 17.8% were female, and the mean body mass index (BMI) was 30.7. Seven (9.6%) patients who underwent mechanochemical ablation experienced saphenous vein closure flush with the femoral vein. Eleven (15%) patients experience extension of thrombus to less than 50% of the diameter of the femoral vein and one patient experienced complete thrombosis of the femoral vein. There was no significant difference in age, sex, or comprehensive classification system for chronic venous disorders between the group with thrombus extension and the group without, with the exception of BMI. The mean BMI in the group with thrombus extension was 26.8 vs. 32 in the group without (P = 0.02). There was no significant difference between the 2 groups in sclerosant volume used, distance between catheter tip and SFJ, and mean diameter of GSV in the thigh.ConclusionsIn this cohort, the incidence of thrombus extension into the femoral vein with mechanochemical ablation was high relative to rates of thrombus extension associated with reported rates of thermal ablation. Further investigation with larger cohorts, and standardized reporting is required to characterize the true rate of thrombus extension after mechanochemical ablation and identify maneuvers which may prevent thrombus extension.

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A long and narrow pulmonary vein thrombus attached to the wall of a pulmonary vein.

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