Pulmonary Vein Thrombosis

Pulmonary vein thrombosis can be idiopathic or be seen with primary and secondary tumors of the lung or as a rare early complication of lobectomy and lung transplantation. If unrecognized, it can lead to pulmonary gangrene, peripheral embolization, pulmonary hypertension, and pulmonary edema.

Conventional pulmonary angiography may allow a presumptive diagnosis of pulmonary vein thrombosis in the setting of a normal arterial phase is normal by revealing absent venous outflow from the affected lung. Improper image acquisition times can lead to a false positive study in cases of delayed opacification of normal pulmonary veins (for example, as seen with atelectasis, neoplasm, and other causes of shunting of pulmonary blood flow).

CTA and MRA can demonstrate the thrombus. MRI may be able to differentiate bland from tumor thrombus, with the latter demonstrating enhancement and abnormal signal extending through the vessel wall.

The case above is from a young patient with Hodgkin disease, who presented with left-sided pleuritic chest pain a month after sternotomy for mediastinal exploration and biopsy of a mediastinal tumor (pink arrow). CTA performed to rule out pulmonary arterial embolism showed a filling defect in a segmental branch of the right inferior pulmonary vein (white arrows).

References

• Gyves-Ray KM, Spizarny DL, Gross BH. Unilateral pulmonary edema due to postlobectomy pulmonary vein thrombosis. AJR Am J Roentgenol. 1987 Jun;148(6):1079-80.
• Selvidge SD, Gavant ML. Idiopathic pulmonary vein thrombosis: detection by CT and MR imaging. AJR Am J Roentgenol. 1999 Jun;172(6):1639-41.