Renal Infarction in a Patient with Pulmonary Vein Thrombosis after Left Upper Lobectomy

Abstract

A 43-year-old male experienced renal infarction (RI) following left upper lobectomy for lung cancer. The patient complained of acute-onset severe left flank pain on the 14th postoperative day. A contrast-enhanced computed tomography (CT) of the abdomen revealed RI by a large wedge-shaped defect in the left kidney. A chest CT scan located the thrombus in the stump (a blind-ended vessel) of the left superior pulmonary vein. Therefore, thromboembolic RI caused by pulmonary vein thrombosis was suspected. Anticoagulation therapy was initiated with heparin and warfarin to treat RI and to prevent further embolic episodes. Two months later, pulmonary vein thrombosis had resolved without the appearance of additional peripheral infarction. This case emphasizes the need to consider thrombus in the stump of the pulmonary vein as a cause of RI.

Case report: Renal infarction by paradoxical embolism through the patent foramen ovale as an unusual cause of post-operative abdominal pain after sleeve gastrectomy

“…Post-operative pain from renal infarction has been recently reported, but in this case arose from thrombus formation in a resected pulmonary vein stump and hence, not a true paradoxical emboli [6]. Only a limited number of paradoxical renal emboli have been reported and usually present as spontaneous, not post-operative, abdominal pain [7], [8], [9].…”

Acute limb ischemia of the lower extremity associated with left upper lobe surgery for primary lung cancer

“…Thrombosis formation in the PV stump after pneumectomy has recently been reported as an extremely rare cause of acute arterial embolism. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Including the current cases, most of these patients underwent LUL, and two patients (17%) underwent left upper division segmentectomy. Although the brain, kidney, and spleen are frequent sites of embolism, the limbs are relatively rarely afflicted by embolism, and these are the first cases of ALI caused by PV thrombus after pneumectomy for primary lung cancer to be reported in English.…”

“… 1 Thrombosis formation in the pulmonary vein (PV) stump after pulmonary lobectomy has recently been reported as an extremely rare cause of acute arterial embolism. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 To our knowledge, however, no cases of ALI of the lower extremities encountered after surgery for primary lung cancer have been reported in the English literature.…”

Pulmonary vein thrombosis in two cases with malignant disease

“…Hayvan deneylerinde pulmoner ven obstrüksiyonunun akciğer konjesyonu, serum ekstravazasyonu ve lobar konsolüdasyon ile sonuçlanan alveolar hemoraji gösterilmiştir [4]. görüntüleme olanakları vardır [1,9]. PVT direk radyogramda pulmoner venlerde genişleme, sağ kalp yüklenmesi bulguları, akciğerde lokal havalanma artışı ve alveolar hemorajiye bağlı yama tarzında opasiteler görülebilir.…”

“…PVT kardiak şantlar ya da pulmoner arteriovenöz malformasyon-fistüller yolu ile sistemik arteryel ve venöz dolaşıma ulaşabilir. Bu yolla renal arter oklüzyonuna ve serebral arteryel dolaşıma girerek iskemik değişikliğe, sonrasında infarkta yol açan PVT olgu bildirileri vardır [9,10].…”