Published online Nov 26, 2016. doi: 10.4330/wjc.v8.i11.684
Peer-review started: June 24, 2016
First decision: July 11, 2016
Revised: August 11, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 26, 2016
Processing time: 156 Days and 7.5 Hours
Pulmonary vein thrombosis (PVT) is a rarely encountered disease entity with varied clinical presentations. It is usually associated with lung carcinoma, lung surgeries and as a complication of the radiofrequency catheter ablation procedure for atrial fibrillation. Its clinical manifestations can vary from mild hemoptysis to lung infarction with hemodynamic compromise. A 76-year-old male presented with a 2-d history of pleuritic left sided chest pain. His past medical history included polycythemia vera, atrial fibrillation, coronary artery disease, pulmonary embolism and pulmonary hypertension. Chest radiograph was normal, troponins were normal and the 12-lead electrocardiogram did not show any ischemic changes. A computerized tomography pulmonary angiogram revealed a filling defect in the left lower lobe pulmonary vein. He was treated with subcutaneous enoxaparin and his symptoms improved. This case highlights a rare etiology of chest pain and the first reported case of the association of polycythemia vera and pulmonary vein thrombosis. A high index of suspicion is required for appropriate diagnostic work up. PVT can mimic pulmonary embolism. The diagnostic work up and treatment strategies depend on acuity of presentation.
Core tip: Pulmonary vein thrombosis (PVT) is a rare but potentially life-threatening disease entity. Its signs and symptoms are often non-specific and it can be difficult to diagnose unless there is a high index of clinical suspicion. Misdiagnosis can lead to grave consequences. We describe a case of PVT in the setting of polycythemia vera. The patient had presented with symptoms of pleuritic chest pain and the workup revealed a thrombus in the left inferior pulmonary vein. This association of polycythemia vera with PVT has not been reported in the literature previously. The PVT is a less known disease process and with this manuscript, we would like to briefly review its causes, presentation and treatment options.