Yoon Hyun Ju, Kim Kye Hun, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun
Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, Korea.
Director of Echocardiography and Cardiac Imaging Laboratory, Director of heart Failure Clinic Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
J Cardiothorac Surg. 2019 Nov 12;14(1):196. doi: 10.1186/s13019-019-1013-9.
Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature.
A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved.
The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored.
无肺外栓塞源的肺血管原发性血栓形成并不常见。在此，我们报告2例肺切除术后残余肺血管残端血栓形成并伴有栓塞事件的病例，并对相关文献进行复习。
一名75岁女性因急性脑梗死前来评估心脏栓塞源。该患者2年前因肺癌接受了左上叶切除术。心血管成像显示左上肺静脉残端内有一个大小约为1.6厘米×1.4厘米的血栓。由于患者拒绝手术清除血栓，故采用华法林抗凝治疗。一名57岁女性，有10年前右肺切除术史，出现呼吸困难。心血管成像显示右肺动脉残端有一个大小为1.7×1.5厘米的血栓，左下肺段肺动脉有小的肺栓塞。该患者采用华法林长期抗凝治疗，血栓和肺栓塞均消失。
目前的病例表明，即使在肺切除术后数年，残余肺血管结构也可能发生非常晚期的血栓形成以及随后致命的栓塞并发症。因此，在肺切除手术中应尽量减少残余血管结构的死腔，并应仔细监测与血管残端血栓形成相关的延迟性血栓栓塞并发症的发生。
