Risk of stroke even after dissipation of a thrombus in the pulmonary vein stump after lobectomy

INTRODUCTION AND IMPORTANCE: Thrombosis in the pulmonary vein stump (PVS) after lung resection has been reported as a cause of cerebral infarction (CI). However, there is limited research focusing on thrombosis in the PVS. Although anticoagulant therapy is performed in clinical settings, the optimal duration of anticoagulant therapy is not established. In addition, no case leading to CI after withdrawal of the anticoagulant therapy has been reported. CASE PRESENTATION: An 81-year-old woman with lung cancer underwent left lower lobectomy. Since a thrombus was detected in the PVS 6 months after the operation, anticoagulant therapy was started. The thrombus disappeared 1 month later, and the medication was discontinued. However, only 23 days after discontinuation, the patient developed CI. CLINICAL DISCUSSION: This case was considered as cardiogenic CI due to a thrombus in the PVS because of the presence of the past thrombus, the distribution of infarction, and the absence of atrial fibrillation. The length of PVS in this case was longer than that reported previously, which could have caused turbulence and congestion leading to thrombogenesis. As long as patients have a long neck PVS, there might be a potential risk of thrombosis. CONCLUSION: We must recognize the risks associated with the discontinuation of anticoagulant therapy for thrombosis in PVS even after thrombus dissipation.