Left superior pulmonary vein stump thrombosis and right renal infarction after left upper lobectomy: case report and lit
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CASE REPORT
Left superior pulmonary vein stump thrombosis and right renal infarction after left upper lobectomy: case report and literature review Cheng‑Yang Song1 · Daisuke Kimura1 · Fumie Sato1 · Takehiro Sakai1 · Takao Tsushima1 · Ikuo Fukuda1 Received: 18 June 2019 / Accepted: 1 September 2019 © The Japanese Association for Thoracic Surgery 2019
Abstract Left upper lobectomy (LUL) has been considered to have a higher risk of thrombus formation in the pulmonary vein stump (PVS) than other lobectomies. A case of thrombus formation in the PVS and right renal infarction detected by contrastenhanced computed tomography (CECT) 12 days after LUL is presented. The thrombus in the PVS was considered to be related to the renal infarction because of the lack of other potential explanations. After intravenous heparin treatment for 1 week and continuous oral anticoagulation, the thrombus in the PVS became smaller 3 months after the operation, and it basically disappeared after 1 year. Scar formation was detected in the area of renal infarction 3 months after the operation, and no specific change was detected from then on. One should consider performing postoperative chest and abdominal CECT routinely within 1 week after LUL, and, if thrombosis is found, antithrombotic therapy might then be given. Keywords Left upper lobectomy · Pulmonary vein stump thrombus · Renal infarction
Introduction Thrombus in the stump of the left superior pulmonary vein (LSPV) after left upper lobectomy (LUL) is considered a potential risk factor for infarction of vital organs. There have been some reports of cerebral infarction after LUL [1, 2]. In comparison, reports of renal infarction after LUL are very rare. Thus, a case of a patient who was found to have thrombus formation in the LSPV stump and right renal infarction after LUL is presented.
Case presentation A 70-year-old male smoker was referred to our hospital with a peripheral nodule in the left upper lobe. The nodule’s diameter was 2.7 cm on contrast-enhanced CT (CECT), and it was diagnosed as a squamous cell carcinoma by bronchoscopic biopsy. The clinical stage was cT1cN0M0 (c-stage IA3). The patient’s smoking index was 1560. His * Daisuke Kimura d‑suke@hirosaki‑u.ac.jp 1
Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Hirosaki University, 5 Zaifu‑cho, Hirosaki 036‑8562, Aomori, Japan
height and weight were 168 cm and 78 kg, respectively, for a body mass index (BMI) of 27.6 kg/m2. The patient had a history of hypertension and cerebral infarction and had no history of diabetes mellitus or hyperlipidemia. The patient had no history of other tumors. The preoperative serum carcinoembryonic antigen level was 2.2 ng/ml. No preoperative radiotherapy or chemotherapy was performed. In the 3 years prior to surgery, the patient underwent percutaneous coronary intervention (PCI) and coronary stent implantation for acute myocardial infarction (AMI). He had been on oral anticoagulation (clopidogrel sulfate) for 3 years up to one and a half months before surg
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