Pulmonary Vein Thrombosis: An Unlikely Cause of Chest Pain

Figures

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  Figure 1. 12-lead electrocardiogram performed for evaluation of chest pain with sinus rhythm with non-specific ST-T changes

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  Figure 2. Coronary computer angiography A and B show the right inferior pulmonary vein is small in caliber, measuring 0.5 sq cm in area. The right lower pulmonary vein appears partially chronically occluded with a filling defect. Its branches correspond to the posterior basilar right lower lung.

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  Figure 3. TEE 2D TEE of the RIPV performed at 45º-60º showed turbulent flow seen with CF-Doppler (4A) and PW-spectral Doppler has pulmonary vein S & D waves velocities at 0.75 m/s (4B); both findings are associated with pulmonary vein thrombosis and obstruction. 2C. 45º-60º shows the pulmonary vein had a small ostium caliber with an echogenic structure decreasing its lumen. The 3D TEE (2D) shows the echogenic structure is a thrombus. 2D TEE: two-dimensional transesophageal echocardiogram; 3D TEE: three-dimensional transesophageal echocardiogram; RIPV: right inferior pulmonary vein; PW-Doppler: pulse wave Doppler; CF-Doppler: color flow Doppler; S wave Velocity: pulmonary systolic vein flow; D wave velocity: pulmonary diastolic vein flow

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  Figure 4. Chest CTA On the left (4A), dedicated chest CTA performed at baseline with occlusion of the RIPV (red arrow). On the right (4B), follow-up chest CTA performed at 12 months with DOAC treatment shows resolution of the RIPV thrombus. RIPV: right inferior pulmonary vein; CTA: computer angiography; DOAC: direct oral anticoagulant