Pulmonary vein thrombosis in a patient with polycythemia vera

Table 1 Diagnostic modalities used in the diagnosis of pulmonary vein thrombosis with the findings and drawbacks

Type of modality	Findings	Drawbacks
Chest X-ray	Increased vascular marking, increased hilar size Consolidation, atelectasis Mitral configuration of pulmonary conus (extensive PVT)	Nonspecific in the setting of coexistent infections Variable findings
CT angiography/multidetector CT	Longer delays of contrast clearance on the venous phase Filling defect in pulmonary veins	Requires IV contrast Artifact from heart motion, dense contrast, poorly opacified blood can leads the PVT undetected
TEE	Can detect the thrombus when it extends to the left atrium Echo dense thrombus occluding the pulmonary veins	Invasive, requires sedation Can’t detect the distal PVT
MRI	Least invasive methods Can differentiate blood clot from tumorous clot	Expensive Needs cooperative patients with stable cardiac rhythm
Pulmonary angiography	Failure to enhance the vein lumen A partial filling defect surrounded by normal contrast	Invasive and requires the contrast exposure Possibility of injury to the pulmonary artery, cardiac perforation, cardiac arrest

PVT: Pulmonary vein thrombosis; CT: Computerized tomography; TEE: Transesophageal echocardiography; MRI: Magnetic resonance imaging.