Advertisement

Left superior pulmonary vein stump thrombosis and right renal infarction after left upper lobectomy: case report and literature review

  • Cheng-Yang Song
  • Daisuke KimuraEmail author
  • Fumie Sato
  • Takehiro Sakai
  • Takao Tsushima
  • Ikuo Fukuda
Case Report
  • 17 Downloads

Abstract

Left upper lobectomy (LUL) has been considered to have a higher risk of thrombus formation in the pulmonary vein stump (PVS) than other lobectomies. A case of thrombus formation in the PVS and right renal infarction detected by contrast-enhanced computed tomography (CECT) 12 days after LUL is presented. The thrombus in the PVS was considered to be related to the renal infarction because of the lack of other potential explanations. After intravenous heparin treatment for 1 week and continuous oral anticoagulation, the thrombus in the PVS became smaller 3 months after the operation, and it basically disappeared after 1 year. Scar formation was detected in the area of renal infarction 3 months after the operation, and no specific change was detected from then on. One should consider performing postoperative chest and abdominal CECT routinely within 1 week after LUL, and, if thrombosis is found, antithrombotic therapy might then be given.

Keywords

Left upper lobectomy Pulmonary vein stump thrombus Renal infarction 

Notes

Compliance with ethical standards

Conflict of interest

Cheng-Yang Song, Daisuke Kimura, Fumie Sato, Takehiro Sakai, Takao Tsushima, Ikuo Fukuda have no conflicts of interest.

References

  1. 1.
    Yamamoto T, Suzuki H, Nagato K, Nakajima T, Iwata T, Yoshida S, et al. Is left upper lobectomy for lung cancer a risk factor for cerebral infarction? Surg Today. 2016;46:780–4.CrossRefGoogle Scholar
  2. 2.
    Hattori A, Takamochi K, Kitamura Y, Matsunaga T, Suzuki K, Oh S, et al. Risk factor analysis of cerebral infarction and clinicopathological characteristics of left upper pulmonary vein stump thrombus after lobectomy. Gen Thorac Cardiovas. 2019;67:247–53.CrossRefGoogle Scholar
  3. 3.
    Inoue H, Nishiyama N, Mizuguchi S, Nagano K, Izumi N, Komatsu H, et al. Clinical value of exogenous factor XIII for prolonged air leak following pulmonary lobectomy: a case control study. BMC Surg. 2014;14:109.CrossRefGoogle Scholar
  4. 4.
    Ohtaka K, Hida Y, Kaga K, Kato T, Muto J, Nakada-Kubota R, et al. Thrombosis in the pulmonary vein stump after left upper lobectomy as a possible cause of cerebral infarction. Ann Throac Surg. 2013;95:1924–9.CrossRefGoogle Scholar
  5. 5.
    Seki M, Endo M, Kidani M, Kobayashi H, Sato H, Noto T. A rare case of left atrial thrombus after left upper pulmonary lobectomy. Jpn J Thorac Cardiovasc Surg. 1989;37(7):89–103 (Japanese) Google Scholar
  6. 6.
    Oura H, Hirose M, Aikawa H, Ishiki M. Abdominal organ infarction encountered immediately after surgery of primary lung cancer. Jpn J Thorac Surg. 2005;58:137–42 (Japanese) Google Scholar
  7. 7.
    Nagaoka E, Yano M, Sugano T, Miyamoto T. Thrombus in the left superior pulmonary vein after left upper pulmonary lobectomy. J Thorac Cardiovasc Surg. 2008;135:709–10.CrossRefGoogle Scholar
  8. 8.
    Sawada T, Watanabe Y, Ohura H, Handa M. Abdominal organ infarction encountered after surgery for primary lung cancer. J Jpn Assoc Chest Surg. 2009;49:49–52 (Japanese) Google Scholar
  9. 9.
    Asteriou C, Barbetakis N, Efstathiou A, Kleontas A, Tsilikas C. Renal artery thrombosis following lobectomy for lung cancer. Case Rep Oncol. 2010;3:208–11.CrossRefGoogle Scholar
  10. 10.
    Tamaki M, Miura K, Norimura S, Kenzaki K, Yosizawa K. Renal infarction and acute arterial obstruction of the lower extremity encountered after surgery for primary lung cancer. Jpn J Thorac Surg. 2013;66:138–41 (Japanese) Google Scholar
  11. 11.
    Ichimura H, Ozawa Y, Nishina H, Shiotani S. Thrombus formation in the pulmonary vein stump after feft upper lobectomy: a report of four cases. Ann Thorac Cardiovas. 2014;20:613–6.CrossRefGoogle Scholar
  12. 12.
    Manabe S, Oshima Y, Nakano M, Fujii T, Maehara T, Nitta K, et al. Renal infarction in a patient with pulmonary vein thrombosis after left upper lobectomy. Case Rep Nephrol Urol. 2014;4:103–8.CrossRefGoogle Scholar
  13. 13.
    Koga T Mori T, Shibata H, Ikeda K, Shiraishi K, Suzuki M. Two cases of organ infarction due to thrombus in pulmonary vein stump after left lung lobectomy. J Jpn Assoc Chest Surg. 2016;30(5):97–103 (Japanese) Google Scholar
  14. 14.
    Harada R, Yunoki K, Sugiyama H, Yamamoto H, Kondo J, Watanabe K, et al. Left superior pulmonary venous thrombosis complicated with splenic infarction after video-assisted thoracoscopic left upper lobectomy. J Cardiol Cases. 2017;16:1–4.CrossRefGoogle Scholar
  15. 15.
    Inoue S, Kuma S, Ohga T, Tokuishi K, Okabayashi K. Acute limb ischemia of the lower extremity associated with left upper lobe surgery for primary lung cancer. J Vasc Surg Cases Innov Techn. 2018;4:83–6.CrossRefGoogle Scholar
  16. 16.
    Ohtaka K, Hida Y, Kaga K, Iimura Y, Shiina N, Muto J, et al. Pulmonary vein thrombosis after video-assisted thoracoscopic left upper lobectomy. J Thorac Cardiov Sur. 2012;143:E3–E5.CrossRefGoogle Scholar
  17. 17.
    Nakano T, Kaneda H, Kawaura T, Kitawaki T, Murakawa T. Ligating the pulmonary vein at the pericardial reflection is useful for preventing thrombus formation in the pulmonary vein stump after left upper lobectomy. Gen Thorac Cardiovasc Surg. 2019;67:450–6.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular Surgery, Graduate School of MedicineHirosaki UniversityHirosakiJapan

Personalised recommendations