Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2016; 8(11): 684-688
Published online Nov 26, 2016. doi: 10.4330/wjc.v8.i11.684
Pulmonary vein thrombosis in a patient with polycythemia vera
Bhaskar Bhardwaj, Dany Jacob, Amit Sharma, Mouhanna Abu Ghanimeh, Paramdeep Baweja
Bhaskar Bhardwaj, Dany Jacob, Amit Sharma, Mouhanna Abu Ghanimeh, Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, United States
Paramdeep Baweja, Department of Cardiology, Truman Medical Center, Kansas City, MO 64108, United States
Author contributions: All the authors contributed to the paper.
Institutional review board statement: Not needed for the case report as per institution review board of University of Missouri Kansas City policies.
Informed consent statement: The patient involved in this study gave written informed consent.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bhaskar Bhardwaj, MD, Resident Physician, Department of Internal Medicine, University of Missouri Kansas City School of Medicine, 2301 Holmes Street, Kansas City, MO 64108, United States. bhardwajb@umkc.edu
Telephone: +1-816-4044862
Received: June 21, 2016
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
Abstract

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.

Keywords: Pulmonary veins, Polycythemia rubra vera, Thrombosis/etiology, Thrombosis/radiography

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.