Abstract
Pulmonary vein thrombosis (PVT) is a rarely encountered disease entity with varied clinical presentations. It has been reported to be associated with underlying lung malignancy in multiple case reports. Diagnosis can be challenging due to nonspecific symptoms on presentation. Herein, we report a 67-year-old male patient with a history of extensive smoking and chronic obstructive pulmonary disease (COPD) who presented with multiple hemoptysis episodes. CT scan of the chest with contrast showed multiple right lower lobe (RLL) lung masses and a thrombus in the inferior pulmonary vein. After various imaging modalities and transthoracic biopsy of the lung mass, the patient was diagnosed with pulmonary vein tumor thrombus secondary to poorly differentiated bronchogenic carcinoma with intracardiac extension. The patient was started on Eliquis for anticoagulation and is currently in the process of beginning chemo/radiation therapy for the underlying malignancy.
Highlights
Pulmonary vein thrombosis (PVT) is a rare and underdiagnosed clinical entity
Trans-esophageal echo and cardiac MRI were done as an outpatient confirming a 1.7 cm x 1.4 cm x 1.3 cm left atrial tumor thrombus mass extending from the right lower lobe (RLL) lung mass through the right inferior pulmonary vein (Figures 3-4)
A: a tumor thrombus extending through the right inferior pulmonary vein; B: left atrial tumor thrombus
Summary
Pulmonary vein thrombosis (PVT) is a rare and underdiagnosed clinical entity. The majority of cases are associated with primary or metastatic lung malignancy and lung surgery -- lung transplantation or lobectomy [1]. A 67-year-old male with a history of extensive smoking and chronic obstructive pulmonary disease (COPD) presented to the hospital for evaluation of multiple episodes of hemoptysis and abnormal findings on CT scan of the chest His symptoms started a few months prior to presentation with a productive cough, for which he received several rounds of antibiotics prescribed by his primary care physician. A: showing multiple masses in the lower lobe of the right lung likely represent lung malignancy (red arrow); B: showing a clot likely representing a tumor thrombus in the left atrium extending from the right lower lobe (RLL) pulmonary veins (red arrow). Trans-esophageal echo and cardiac MRI were done as an outpatient confirming a 1.7 cm x 1.4 cm x 1.3 cm left atrial tumor thrombus mass extending from the RLL lung mass through the right inferior pulmonary vein (Figures 3-4). A: a tumor thrombus extending through the right inferior pulmonary vein (red arrow); B: left atrial tumor thrombus (red arrow)
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