Nakano Takahito, Inaba Mayumi, Kaneda Hiroyuki
Department of Thoracic Surgery, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchishi, Osaka, 570-8507, Japan.
Department of Diagnostic Pathology, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchishi, Osaka, 570-8507, Japan.
Surg Case Rep. 2017 Sep 11;3(1):101. doi: 10.1186/s40792-017-0376-1.
Thrombus formation in the pulmonary vein stump after pulmonary resection has recently been identified as a cause of systemic thrombosis including brain infarction. However, there is limited research focusing on the clinical course of pulmonary vein stump thrombus, and optimal treatment and prevention strategies of this important complication have not been established.
A 77-year-old woman was diagnosed with lung cancer of the left upper lobe, cT4N2M0, cStage IIIB. As the tumor was considered to be completely resectable, the patient underwent a left upper lobectomy with angioplasty of the left pulmonary artery. The final pathological stage was pT4N2M0, pStage IIIB. The patient developed paralysis of the right upper limb and dysarthria on the 8th postoperative day. Diffusion-weighted magnetic resonance imaging (MRI) of the brain showed multiple high-intensity signals in the area of the left middle cerebral artery, which were not detected on preoperative MRI. She was diagnosed with a cerebral infarction and started on acute-phase treatment including anticoagulation with continuous intravenous heparin infusion. The neurological symptoms improved the following day. Contrast-enhanced chest CT scan revealed thrombus in the left superior pulmonary vein stump measuring 10 mm in diameter. She had no comorbidity related to the cerebral attack. After the treatment was initiated, her symptoms became stable. However, symptoms of altered consciousness, dysarthria, and hemiparesis re-occurred on the 19th postoperative day and improved within an hour. The thrombus in the left superior pulmonary vein stump disappeared on follow-up contrast-enhanced chest CT performed the same day.
This is the first report of recurrent brain attack caused by thrombosis in the pulmonary vein stump in a patient receiving anticoagulant therapy. The present case suggests the possibility of thrombus mobilization causing recurrent systemic thrombosis, and this important complication needs to be considered in future clinical practice.
肺切除术后肺静脉残端血栓形成最近被确认为包括脑梗死在内的全身性血栓形成的一个原因。然而，针对肺静脉残端血栓临床病程的研究有限，且尚未确立针对这一重要并发症的最佳治疗和预防策略。
一名77岁女性被诊断为左上叶肺癌，cT4N2M0，cⅢB期。由于肿瘤被认为可完全切除，患者接受了左上叶切除术及左肺动脉血管成形术。最终病理分期为pT4N2M0，pⅢB期。患者术后第8天出现右上肢麻痹和构音障碍。脑部弥散加权磁共振成像（MRI）显示左侧大脑中动脉区域有多个高强度信号，术前MRI未检测到。她被诊断为脑梗死，并开始进行急性期治疗，包括持续静脉输注肝素进行抗凝。次日神经症状有所改善。增强胸部CT扫描显示左肺上静脉残端有血栓，直径为10毫米。她没有与脑部发作相关的合并症。治疗开始后，她的症状趋于稳定。然而，术后第19天意识改变、构音障碍和偏瘫症状再次出现，并在1小时内有所改善。同一天进行的随访增强胸部CT显示左肺上静脉残端的血栓消失。
这是首例接受抗凝治疗的患者因肺静脉残端血栓形成导致复发性脑部发作的报告。本病例提示血栓移动导致复发性全身性血栓形成的可能性，在未来临床实践中需要考虑这一重要并发症。
