Abstract 12956: Pulmonary Vein Thrombosis: A Rare Complication Following Infection With SARS-CoV-2

Abstract

Case Presentation: 49 year old male with past medical history of hypertension who presented with dyspnea and nasal congestion of three days duration. Testing for SARS-CoV-2 was positive. ECG revealed sinus tachycardia with an incomplete right bundle branch block. D-dimer was elevated 3,388 ng/mL and CT pulmonary angiogram revealed thrombosis of a right lower lobe pulmonary vein extending to the posterior aspect of the left atrium along with consolidation in the right lower lobe concerning for pulmonary infarct versus congestion in the setting of pulmonary venous thrombosis. The patient was admitted and started on intravenous unfractionated heparin. Echocardiogram performed later in the day revealed left ventricular segmental wall motion to be globally hypokinetic with mildly reduced ejection fraction of 45%. Left atrium was severely enlarged. No thrombus could be seen in the left atrium or ventricle. Bubble study revealed no evidence of atrial septal defect or patent foramen ovale. The next day after admission, his symptoms had resolved and he was back to his baseline, so he was discharged. No supplemental oxygen was required. Heparin was transitioned to apixaban, and metoprolol succinate and lisinopril were initiated. Cardiac monitoring during the hospitalization did not demonstrate any arrhythmias. Etiology of his pulmonary vein thrombosis was ultimately felt to be due to coagulopathy secondary to COVID-19 given that the patient’s medical history was otherwise unremarkable. Discussion: This case describes a rare complication due to infection with SARS-CoV-2. Pulmonary artery thrombi are common with SARS-CoV-2 infection, but pulmonary vein thrombi are rare. With thrombus extending to the left atrium, cardiac monitoring was performed and did not reveal evidence of atrial fibrillation or atrial flutter. With no other identifiable cause of the thrombus, the etiology was likely due to SARS-CoV-2 infection.