SHM Converge Scientific Abstract ePoster Gallery-Bizzare Blockage: Unexpected Clot in an Unexpected Place

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This case report describes an uncommon and potentially dangerous condition: pulmonary vein thrombosis (PVT), a rare clot in the pulmonary veins. PVT is most often reported in patients with major lung surgery or hypercoagulable states such as antiphospholipid syndrome.<br /><br />The patient was a 48-year-old man with a history of unprovoked deep vein thrombosis and pulmonary embolism who presented with severe chest pain, dizziness, and brief syncope. Initial testing showed T-wave inversions and elevated troponin, raising concern for non-ST-elevation myocardial infarction. However, cardiac catheterization showed normal coronary arteries and normal left ventricular function. A CT angiogram of the chest, performed to evaluate for pulmonary embolism, unexpectedly revealed thrombus in the posterior right pulmonary vein. Echocardiography showed mildly reduced right ventricular function but no major structural abnormality.<br /><br />Review of his prior history revealed a cryptogenic stroke four years earlier and a later hospitalization for extensive DVT and bilateral pulmonary emboli. Thrombophilia testing was positive for lupus anticoagulant, leading to a diagnosis of antiphospholipid syndrome, which likely explained his recurrent thrombotic events. He was treated with heparin and transitioned to warfarin.<br /><br />The report emphasizes that PVT can present with nonspecific symptoms such as chest pain, dyspnea, hemoptysis, or shortness of breath, and may be missed without imaging. Diagnosis is usually made with CT angiography, transesophageal echocardiography, or MR venography. Severe complications can include stroke, shock, cor pulmonale, and lung necrosis. There are no formal treatment guidelines, but systemic anticoagulation is the mainstay, with invasive interventions reserved for severe cases.<br /><br />Overall, clinicians should consider PVT in patients with unexplained chest pain or thrombotic history, especially those with antiphospholipid syndrome.

Asset Subtitle

Aung Naing

Meta Tag

Author List Aung Naing, Mark Flemmer, Reece Q. Hoerle

Category Clinical Vignettes

Concept Pulmonary Vein Thrombosis

Concept Antiphospholipid Antibody Syndrome

Concept Systemic Anticoagulation

Concept Embolic Stroke

Concept Cardiogenic Shock

Distinguished Non-Finalist

Presenter Organization EVMS at ODU

Presenting Author Aung Naing

Track Adult

Keywords

pulmonary vein thrombosis

antiphospholipid syndrome

lupus anticoagulant

deep vein thrombosis

pulmonary embolism

chest pain

CT angiography

warfarin

cryptogenic stroke

systemic anticoagulation

Pulmonary Vein Thrombosis

Antiphospholipid Antibody Syndrome

Systemic Anticoagulation

Embolic Stroke

Cardiogenic Shock