Abstract
Pulmonary artery stump thrombosis is a recognized complication after pneumonectomy. However, to our knowledge, there is only one case report of delayed development of this complication. We report the case of a 68 year-old man who presented with chest pain nearly ten years after undergoing a right pneumonectomy for lung cancer. Workup identified a pulmonary artery stump thrombosis. Due to the acute onset of his symptoms, the patient was anticoagulated, and his chest pain resolved. While the literature suggests that anticoagulation is not generally required for stump thromboses, we highlight features of this case that may indicate an increased risk of clinically important sequelae. Taking previous reports into account, we argue that a specific subset of patients with stump thrombosis may benefit from systemic anticoagulation.
Highlights
The prevalence of pulmonary artery stump thrombosis after pneumonectomy is approximately 12%.[1,2]
Controversy exists in the literature whether or not a right pulmonary artery stump is at greater risk of a thrombus than a left stump
Review of the scan performed six weeks earlier, during his admission for chronic obstructive pulmonary disease (COPD) exacerbation, revealed an area of increased density in the right pulmonary artery stump, consistent with the location of the thrombus. These scans suggest that the thrombus developed during the period of clinical decline
Summary
The prevalence of pulmonary artery stump thrombosis after pneumonectomy is approximately 12%.[1,2]. A recent case report linked a pulmonary artery stump thrombosis occurring ten years after right pneumonectomy with multiple pulmonary emboli and pulmonary hypertension.[3] These authors suggest consideration of prolonged postoperative anticoagulation in all patients undergoing right pneumonectomy to reduce the risk of thromboembolic events. Upon presentation to the ED, a contrasted chest CT was performed which revealed a large thrombus in the right pulmonary artery stump with no evidence of pulmonary emboli (Figure 1).
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