A Case of Chest Jolts: Pulmonary Vein Thrombus Extending into the Left Atrium

Authors

Shaikh Iqbal, MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
Shiavax J. Rao, MedStar Health Internal Medicine Residency Program, Baltimore, MD, USAFollow
Nicholas Bedard, MedStar Union Memorial Hospital, Baltimore, MD, USA and Georgetown University Medical Center, Washington, DC, USA
Christopher J. Haas, MedStar Franklin Square Medical Center, Baltimore, MD, USA and Georgetown University Medical Center, Washington, DC, USA

Abstract

Pulmonary vein thrombosis (PVT) is a rare but life-threatening clinical condition, often found incidentally on imaging. In this report, we present an interesting case of PVT of the left inferior pulmonary vein with extension into the left atrium in a 78-year-old woman presenting with “jolts” in the chest. Initial imaging with plain chest film radiograph showed findings consistent with COPD and no acute intrathoracic process. A CT angiogram of the chest revealed a filling defect consistent with thrombus within the left inferior pulmonary vein extending into the left atrium. A transthoracic echocardiogram was remarkable for a severely enlarged right ventricular cavity with moderately reduced right ventricular systolic function and normal left ventricular size with preserved systolic function. She was not a candidate for any surgical interventions, and she was managed with systemic anticoagulation. Management of PVT mostly depends on the underlying cause as there are no well-defined treatment guidelines. The consensus recommends systemic anticoagulation until thrombus resolution. When anticoagulation is contraindicated, thrombectomy is indicated to restore blood flow. In patients with similar presentation and clinical history it is important to consider PVT, and to focus on prompt diagnosis and early initiation of appropriate treatment.

Recommended Citation

Iqbal, Shaikh; Rao, Shiavax J.; Bedard, Nicholas; and Haas, Christopher J. (2022) "A Case of Chest Jolts: Pulmonary Vein Thrombus Extending into the Left Atrium," Journal of Community Hospital Internal Medicine Perspectives: Vol. 12: Iss. 1, Article 20.
DOI: 10.55729/2000-9666.1019
Available at: https://scholarlycommons.gbmc.org/jchimp/vol12/iss1/20