Latest revision as of 10:48, 19 May 2017

Keywords

Pulmonary vein thrombus;64-MDCT

Pulmonary vein thrombosis (PVT) was hypothesized as rare. However, since 2014, I have published several cases of PVT in elderly patients with chest pain using 64-slice multidetector computed tomography [1]; [2]; [3]; [4]; [5]; [6]; [7]; [8]; [9] ;  [10]. In 2014, I reported that 61% (35 patients) of 57 elderly patients had PVT [9], suggesting that PVT is common in elderly patients with chest pain; however, the pulmonary vein that is likely to contain a thrombus is unknown. I reviewed the images of PVT from 26 of 35 patients with PVT. The mean age of the 26 patients was 74.1 ± 7.1 years (mean ± standard deviation) and the range was from 60 years to 93 years of age. Fourteen patients had a thrombus in the right lower pulmonary vein (RLPV), and 14 patients had a thrombus in the left lower pulmonary vein (LLPV). Five patients had a thrombus in the right middle pulmonary vein (RMPV), and five patients had a thrombus in the right upper pulmonary vein (RUPV). Nine patients had a thrombus in the left upper pulmonary vein (LUPV). A total of 47 thrombi were identified in 26 patients with PVT, and 15 patients had more than two pulmonary vein thrombi. The lower pulmonary veins had 28 thrombi (60%). The right and left lower pulmonary veins are likely to contain a pulmonary vein thrombus. The right pulmonary vein had 24 thrombi (51%). The right pulmonary vein (24) and left pulmonary vein (23) contain thrombi at a similar frequency.

The ratio of pulmonary vein thrombus existence is RLPV = 3, RMPV = 1, RUPV = 1, LLPV = 3, and LUPV = 2 (Fig. 1).

Fig. 1. The frequency ratio of the pulmonary vein thrombi is shown. The frequency ratio of the right lower pulmonary vein (RLPV) is 3. The frequency ratio of the right middle pulmonary vein (RMPV) is 1. The frequency ratio of the right upper pulmonary vein (RUPV) is 1. The frequency ratio of the left lower pulmonary vein (LLPV) is 3. The frequency ratio of the left upper pulmonary vein (LUPV) is 2. LA: left atrium; LLPV: left lower pulmonary vein; LUPV: left upper pulmonary vein; RLPV: right lower pulmonary vein; RMPV: right middle pulmonary vein; RUPV: right upper pulmonary vein.

Conflict of interest

The author reports no relationships that could be construed as a conflict of interest.

Acknowledgments

None.

References

1. [1] H. Takeuchi; A thrombus of the right upper pulmonary vein: detection by the use of a 64-MDCT; BMJ Case Rep (Sep 14, 2012) https://doi.org/10.1136/bcr.12.2011.5446 [Published online]
2. [2] H. Takeuchi; 64-MDCT showed the thrombus in the pulmonary vein of the patient with angina pectoris; BMJ Case Rep (Oct 13, 2012) https://doi.org/10.1136/bcr.02.2012.5839 [Published online]
3. [3] H. Takeuchi; 64-MDCT scan demonstrated pulmonary vein thrombus; J Neurol Neurophysiol, S8 (2013), p. 002 https://doi.org/10.4172/2155-9562.S8-002
4. [4] H. Takeuchi; 64-MDCT can depict the thrombi expanded from the left lower pulmonary vein to the left atrium in the patient with angina pectoris; BMJ Case Rep (Apr 3, 2013) https://doi.org/10.1136/bcr.2013-008750 [Published online]
5. [5] H. Takeuchi; Diagnosis of a left lower pulmonary vein thrombus by 64-MDCT; BMJ Case Rep (Jul 25, 2013) https://doi.org/10.1136/bcr-2013-010256 [Published online]
6. [6] H. Takeuchi; How to find a thrombus in a small pulmonary vein that is not enhanced by contrast agents because of a lack of arterial blood flow; BMJ Case Rep (Jul 29, 2013) https://doi.org/10.1136/bcr-2013-010261 [Published online]
7. [7] H. Takeuchi; Floating thrombus in the left upper pulmonary vein dissolved by dabigatran; BMJ Case Rep (Oct 9, 2013) https://doi.org/10.1136/bcr-2013-200836 [Published online]
8. [8] H. Takeuchi; Chest pain caused by pulmonary vein thrombi could be curable by dabigatran; BMJ Case Rep (March 13, 2014) https://doi.org/10.1126/bcr-2013-203186 [Published online]
9. [9] H. Takeuchi; High prevalence of pulmonary vein thrombi in elderly patients with chest pain, which has relationships with aging associated diseases; IJC Heart Vessel, 4 (2014), pp. 129–134 https://doi.org/10.1016/j.ijchv.2014.05.006 [Published online: 6-Jun-2014]
10. [10] H. Takeuchi; Pulmonary vein thrombi in a patient with paroxysmal atrial fibrillation; IJC Heart Vascul, 5 (2014), pp. 63–64 https://doi.org/10.1016/j.ijcha.2014.10.006