Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock.
Department of Lung Cancer and Chest Tumors, The Maria Skłodowska-Curie Memorial National Oncology Institute, Warsaw, Poland.
Adv Respir Med. 2021;89(3):311-315. doi: 10.5603/ARM.a2021.0010. Epub 2021 Apr 19.
Lung cancer surgery is a well-known risk factor for venous thromboembolism. Thus, standard care involves the use of pharmacological and mechanical prophylaxis until discharge from the hospital. Pulmonary artery stump thrombosis (PAST) is a rare condition which can develop months to years after lung cancer surgery. This report describes a patient diagnosed with PAST and the decisions that were made regarding his treatment.
A 67-year-old male was diagnosed with lung cancer due to shortness of breath, dry cough, hemoptysis, and typical chest computed tomography (CT) findings. He underwent right lower lobectomy and mediastinal lymphadenectomy by video-assisted thoracoscopic surgery. The procedure was complicated by the development of a right pleural empyema. After pleural drainage and an antibiotic regimen, he was discharged from the hospital with further improvement. A follow-up CT pulmonary angiography performed three months after lobectomy revealed thrombosis in the right lower lobar pulmonary artery stump. The patient had no symptoms. The attending physician decided to use anticoagulants. Consequently, the patient received low molecular-weight heparin subcutaneously for one month and a non-vitamin-K antagonist oral anticoagulant (NOAC) for the following 5 months. A CT scan performed after 3 months of anticoagulation showed complete resolution of stump thrombosis. Subsequent examinations showed no recurrence of either lung cancer or artery stump thrombosis and no anticoagulant-related bleeding.
Pulmonary artery stump thrombosis can develop after lung cancer surgery. This complication is uncommon and the prognosis is favorable in most treated cases. However, thrombosis may progress, and pulmonary embolism or chronic thromboembolic pulmonary hypertension may develop. Decisions about instituting anticoagulation therapy and its duration are made on an individual basis after considering both the benefits and the potential risks.
肺癌手术是静脉血栓栓塞的已知危险因素。因此，标准治疗包括使用药物和机械预防措施，直到从医院出院。肺动脉残端血栓形成（PAST）是一种罕见的疾病，可在肺癌手术后数月至数年后发生。本报告描述了一名诊断为 PAST 的患者，以及针对其治疗做出的决策。
一名 67 岁男性因呼吸急促、干咳、咯血和典型胸部计算机断层扫描（CT）表现而被诊断为肺癌。他接受了电视胸腔镜辅助右下肺叶切除术和纵隔淋巴结切除术。手术过程中出现右侧脓胸。在进行胸腔引流和抗生素治疗后，他出院并进一步好转。右下肺叶切除术后三个月进行的 CT 肺动脉造影显示右肺下叶肺动脉残端血栓形成。患者无症状。主治医生决定使用抗凝剂。因此，患者接受了一个月的皮下低分子肝素和随后 5 个月的非维生素 K 拮抗剂口服抗凝剂（NOAC）治疗。抗凝 3 个月后的 CT 扫描显示残端血栓完全溶解。随后的检查显示，肺癌或动脉残端血栓均无复发，也无抗凝相关出血。
肺癌手术后可能会发生肺动脉残端血栓形成。这种并发症并不常见，大多数治疗后的预后良好。然而，血栓可能会进展，可能会发生肺栓塞或慢性血栓栓塞性肺动脉高压。在考虑到获益和潜在风险后，会根据个体情况决定是否开始抗凝治疗及其持续时间。
