Iijima Yoshihito, Iwai Shun, Motono Nozomu, Uramoto Hidetaka
Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Kahoku-Gun, Uchinada-Machi, Ishikawa, 920-0293, Japan.
Surg Case Rep. 2022 Dec 2;8(1):215. doi: 10.1186/s40792-022-01574-8.
Thrombosis of the pulmonary vein stump is a common complication after a left upper lobectomy and can be a source of embolism in various organs, such as the kidneys. A renal infarction, on the other hand, is a rare and often lethal condition that is usually diagnosed postmortem. Here, we present a case of renal infarction associated with pulmonary vein stump thrombosis after a left pneumonectomy, which was treated successfully with edoxaban.
A 73-year-old man was diagnosed with squamous cell lung cancer (cT1miN0M0 stage IA1). Due to pneumoconiosis, extensive lymph node infiltration into the pulmonary artery was noted and necessitated an open thoracotomy. Ultimately, a left pneumonectomy was performed. Atrial fibrillation occurred on postoperative day 3, and the patient complained of left-sided abdominal pain. Contrast-enhanced computed tomography revealed a left upper pulmonary vein thrombosis and a left renal infarction. Anticoagulant therapy was immediately initiated with heparin and warfarin. On postoperative day 13, warfarin was replaced with the direct oral anticoagulant edoxaban since the patient's compliance and drug response to warfarin were poor. On postoperative day 19, contrast-enhanced computed tomography revealed a reduction in pulmonary vein stump thrombosis and improvement in renal infarction. Subsequently, the patient was discharged. Three months post-surgery, no infarct lesions or reduced renal function was observed on imaging.
The direct oral anticoagulant edoxaban could be effective in preventing recurrence or exacerbation of pulmonary vein thrombosis associated with renal infarction without bleeding complications.
肺静脉残端血栓形成是左上肺叶切除术后的常见并发症，可能是肾脏等多个器官栓塞的来源。另一方面，肾梗死是一种罕见且通常致命的疾病，通常在尸检时才得以诊断。在此，我们报告一例左肺切除术后发生的与肺静脉残端血栓形成相关的肾梗死病例，该病例通过依度沙班成功治疗。
一名73岁男性被诊断为肺鳞状细胞癌（cT1miN0M0，IA1期）。由于尘肺病，发现广泛的淋巴结浸润至肺动脉，因此需要进行开胸手术。最终实施了左肺切除术。术后第3天出现房颤，患者主诉左侧腹痛。增强计算机断层扫描显示左上肺静脉血栓形成和左肾梗死。立即开始使用肝素和华法林进行抗凝治疗。术后第13天，由于患者对华法林的依从性和药物反应较差，将华法林替换为直接口服抗凝药依度沙班。术后第19天，增强计算机断层扫描显示肺静脉残端血栓形成减少，肾梗死有所改善。随后，患者出院。术后三个月，影像学检查未观察到梗死灶或肾功能减退。
直接口服抗凝药依度沙班可有效预防与肾梗死相关的肺静脉血栓形成的复发或加重，且无出血并发症。
