Ohashi Takuya, Kawago Mitsumasa, Hirai Yoshimitsu, Kiyoi Megumi, Miyasaka Miwako, Yata Yumi, Kawaji Mari, Fusamoto Aya, Iguchi Hideto, Nakanishi Hitomi, Nishimura Yoshiharu
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan.
J Surg Case Rep. 2022 May 25;2022(5):rjac168. doi: 10.1093/jscr/rjac168. eCollection 2022 May.
Our medical team observed a right upper lobe nodule in a 78-year-old man who was treated with warfarin for chronic atrial fibrillation. The nodule was diagnosed as adenocarcinoma via intraoperative frozen sectioning. We performed video-assisted right upper lobectomy and mediastinal lymph node dissection. Warfarin was discontinued in the perioperative period. However, unfractionated heparin was administered. Nonetheless, the patient developed acute arterial occlusion of the lower extremities on post-operative day 7. Contrast-enhanced computed tomography showed thrombosis in the right upper lobe pulmonary vein stump, which was considered to be the cause of the acute arterial occlusion. The patient underwent emergency thrombectomy following which his symptoms immediately improved. Herein, we report a rare case of pulmonary vein thrombosis occurring after a right upper lobectomy. Our findings may facilitate effective clinical decision-making.
我们的医疗团队在一名78岁男性患者中观察到右肺上叶结节,该患者因慢性心房颤动接受华法林治疗。通过术中冰冻切片,该结节被诊断为腺癌。我们进行了电视辅助右肺上叶切除术和纵隔淋巴结清扫术。围手术期停用了华法林。然而,给予了普通肝素。尽管如此,患者在术后第7天出现了下肢急性动脉闭塞。增强计算机断层扫描显示右肺上叶肺静脉残端血栓形成,这被认为是急性动脉闭塞的原因。患者接受了紧急血栓切除术,术后症状立即改善。在此,我们报告一例右肺上叶切除术后发生肺静脉血栓形成的罕见病例。我们的发现可能有助于有效的临床决策。