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Pulmonary vein thrombosis is a sudden blockage of the pulmonary artery or its branches with thrombotic masses. Pathology requires emergency medical care, as it carries a direct threat to life. Pulmonary vein thrombosis is indicated by pain in the chest, blue skin of the neck and face, suffocation, increased heart rate, and collapse.
A thrombus can enter the pulmonary artery from the right atrium or right ventricle, or be brought along the venous bed of the systemic circulation. It creates an obstacle to the normal blood supply to the lung tissue, which often leads to death.
About 0,1% of the world’s population dies every year on Earth precisely because of the presence of a blood clot in the lungs. Moreover, patients in 90% of cases are given the wrong diagnosis, so they do not receive adequate therapy. Otherwise, the number of deaths could be reduced to 2-8%.
About 10% of patients die in the first day or even hours after massive pulmonary vein thrombosis. Within a year, another 25% of case histories will end in death. In general, pulmonary vein thrombosis ranks first among undiagnosed pathological conditions.
Causes of pulmonary vein thrombosis
A thrombus does not form in the pulmonary vein. It gets there with the blood flow from other localizations, clogging the lumen of the vessel.
Therefore, the causes of pulmonary vein thrombosis can be considered:
The patient has a pathology such as deep vein thrombosis of the lower leg. The combination of thrombosis of deep and superficial veins of the leg.
Thrombosis of the inferior vena cava and its offshoots.
Cardiopathology: ischemic heart disease, rheumatism accompanied by stenosis, atrial fibrillation, hypertension, infectious endocarditis, cardiomyopathy, non-rheumatic myocarditis.
Generalized sepsis.
Cancer tumors. Pulmonary vein thrombosis is most often caused by neoplasms of the lungs themselves, the stomach and pancreas.
Thrombophilia, as a pathology of the blood system, which leads to an increase in its coagulability.
APS is a syndrome in which reactions occur in the body that provoke the formation of blood clots. They can be located in a variety of places.
In addition to the causes leading to pulmonary vein thrombosis, risk factors can be identified, including:
Prolonged stay of a person in a forced immobilized state. The danger is: immobility after surgery, bed rest for various diseases, long flights on airplanes or trains, etc.
Damage to the vessel wall: endovascular operations performed, stenting and prosthetics of veins, placement of a venous catheter, oxygen starvation of the body. Various viruses and bacteria, systemic reactions of the body, accompanied by an inflammatory process, can injure the vascular wall.
Venous congestion against the background of slow blood flow through the vessels, which is observed in chronic cardiovascular and pulmonary insufficiency.
The presence of a malignant tumor in the body.
Undergoing treatment with diuretic drugs when taking too large a dose of drugs is required. The more fluid is excreted from the body, the higher the viscosity of the blood, which means that it will be easier for blood clots to form.
Phlebeurysm. This disease is the main reason for the blood to stagnate and blood clots form.
Severe disturbances in metabolic processes, which is observed against the background of diabetes mellitus or obesity.
hemostasis disorders.
Age over 50 and previous surgeries. So, in patients under 40 years of age after surgery against the background of a minor injury, pulmonary artery thrombosis is extremely rare, as an exception. In patients older than 40-50 years, thrombosis acts as a leading factor that worsens the prognosis of surgical intervention. These patients account for up to 75% of all cases of pulmonary vein thrombosis, which ended in death. In this regard, operations performed on the respiratory and peritoneal organs are especially dangerous.
Leading a sedentary lifestyle.
Childbirth, which proceeded with various complications.
Taking hormonal drugs for the purpose of contraception.
Erythremia.
Systemic lupus erythematosus.
Hereditary diseases, for example, congenital deficiency of antithrombin 3.
Smoking. Under the influence of nicotine, vasospasm occurs, blood pressure increases, venous congestion develops, which increases the risk of blood clots.
Survival
A life-threatening condition occurs due to the fact that an obstacle arises in the path of blood flow, which increases pressure in the pulmonary vein. When it becomes too strong, the load on the right ventricle of the heart increases. This leads to heart failure, which often causes the death of the patient.
The right ventricle expands, and little blood enters the left ventricle. This causes a drop in blood pressure levels. The larger the vessel into which the thrombus has fallen, the stronger the violations.
Depending on where exactly the thrombus is located, the percentage of death varies:
If the blockage occurred in the main branch of the pulmonary artery or in its main trunk, then the probability of death of the patient rises to 75%.
If the thrombus stopped in the lobar and segmental branches, then the death of patients occurs in 6% of cases.
With blockage of small pulmonary branches, death is almost always avoided.
Symptoms of pulmonary vein thrombosis
The symptoms of pulmonary vein thrombosis are varied. They depend on how extensive the lesion is, what the general health of the person is, how quickly thrombosis develops. The difficulty in making a correct diagnosis lies in the fact that pulmonary vein thrombosis has many symptoms that manifest themselves in a variety of combinations.
There are several basic signs that may accompany such a pathology:
cardiac syndrome. It develops in the first few hours from the onset of the disease. In this case, the person experiences retrosternal pain. His heart rate rises, collapse may develop. Blood pressure drops sharply, and heart rate can be up to 100 beats per minute. The veins in the neck swell. Approximately 20% of patients develop coronary insufficiency, accompanied by atrial fibrillation. With massive blockage of the vein, the patient develops cor pulmonale, which is manifested by the venous pulse and pulsation of the jugular veins. Edema of the face and neck is not observed.
Pulmonary-pleural syndrome. This syndrome accompanies cardiac disorders and is expressed in the appearance of shortness of breath. The number of breaths per minute reaches 30-40. Although a person lacks air, he does not show a desire to take a sitting position, preferring to lie down. Shortness of breath always accompanies pulmonary vein thrombosis. Against the background of lung perfusion, human skin becomes cyanotic or ashy. Although skin cyanosis is not always a symptom, it is pathognomic for pulmonary vein thrombosis. It develops in only 16% of patients. A more permanent sign should be considered a pronounced pallor of the skin, which develops as a result of a spasm of small vessels.
Abdominal syndrome, which is manifested by a painful attack. Severe pain behind the sternum can be triggered by vasospasm, which occurs in response to violations in their patency, and can be caused by overstretching of the ventricle of the heart. A pulmonary infarction, as a complication of thrombosis, also leads to severe pain that gains intensity during a breath. This condition is characterized by coughing up bloody sputum. Sometimes pain can be localized in the right hypochondrium, which is caused by inflammation of the pleura or intestinal paresis. In this case, the liver increases in size, becomes painful when touched. The patient may develop hiccups, vomiting, belching.
renal syndrome. It is expressed in secretory anuria, when a person stops urinating.
cerebral syndrome. It is manifested by disorders of the brain. A person can lose consciousness, he often has convulsive seizures. Other manifestations of cerebral syndrome: tinnitus, vomiting, dizziness. In severe cases, the patient falls into a coma.
Fever Syndrome. Body temperature rises to subfebrile levels or even higher. This is due to the development of inflammation in the lung tissue. Elevated body temperature persists for 2-12 days. If the patient survived the acute stage, and he was saved, then after 14-21 days he may experience an immunological reaction of the body. It is expressed in the appearance of a skin rash, repeated pleurisy, an increase in the level of eosinophils in the blood.
Most common general symptoms
To increase the likelihood of making a correct diagnosis and saving the patient’s life, one should be aware of indicators of thrombosis such as:
In almost 50% of cases, pulmonary vein thrombosis begins with a short loss of consciousness of the patient, or when he is in a pre-syncope state.
In 45% of cases, the pathology is accompanied by retrosternal pain and pain in the heart.
In 54% of cases, people suffer from suffocation.
In more than 50% of cases, patients develop a pulmonary infarction, which is expressed by chest pain, shortness of breath, bloody cough, and wheezing in the lungs.
Forms of thrombosis
Depending on the course of the disease, there are three forms:
The lightning-fast course of thrombosis, when the death of a person occurs suddenly, within the first 10 minutes from the onset of the first symptoms. The cause of death in a fulminant form of thrombosis is reduced to cardiac arrest, or to suffocation.
An acute form of thrombosis, when the patient has severe pain behind the sternum, breathing becomes intermittent, blood pressure drops sharply. Most often, acute thrombosis causes death of a person in the first day from the onset of its development.
Subacute form, when symptoms develop gradually, leading to pulmonary infarction. The prognosis is more favorable, but death is likely.
Chronic form, when the patient has symptoms of heart and pulmonary insufficiency, which gradually increase their intensity.
Complications of pulmonary vein thrombosis
The complications of pulmonary thrombosis are many and varied. They have an impact on the life expectancy of a person. The main complications of a thrombus in the lungs include: pulmonary infarction, embolism of the vessels of the systemic circulation, increased pressure in the vascular stack of the lungs of a chronic course. The sooner a person receives adequate help for his disease, the less risk that he will develop severe complications.
The main pathological conditions that are provoked by pulmonary thrombosis include:
Lung infarction. A heart attack develops after 2-3 days from the onset of the disease. The complication is accompanied by acute retrosternal pain, bloody sputum, shortness of breath, fever.
Pleurisy. This condition is a consequence of a pulmonary infarction, it is expressed in inflammation of the pleura. The inflammatory reaction develops as a result of sweating of fluid accumulated in the lungs into the pleural cavity.
Pneumonia.
Lung abscess. In the place where the lung infarction happened, the tissues begin to disintegrate. This can lead to the formation of an abscess (abscess).
Acute kidney failure.
The most formidable complication of pulmonary vein thrombosis is the sudden death of a person.
Diagnosis of pulmonary vein thrombosis
The primary goal of diagnosing pulmonary vein thrombosis is to determine the location of the thrombus. It is important to qualitatively and as soon as possible assess the damage that the thrombus caused to the patient’s health, as well as how disturbed the hemodynamics in the body are. It is imperative to find the place from which the thrombus broke off, which will eliminate the recurrence of the pathological condition.
The patient should be placed in the vascular-surgical department, where there is equipment that will allow the highest quality diagnostic measures and start treatment.
Scheme of examination of the patient:
Examination, history taking, a qualitative assessment of risk factors for the presence of pulmonary thrombosis in a patient.
Examination of the gas composition of the blood, conducting a coulogram. This method allows you to clarify the diagnosis, but only on its basis it cannot be assumed that the patient has pulmonary vein thrombosis.
ECG of the heart in dynamics. The procedure is required to perform a differential diagnosis with heart failure, myocardial infarction and pericarditis. The method makes it possible to determine the further tactics of managing the patient, but the direct diagnosis of “pulmonary vein thrombosis” does not allow to establish.
X-rays of light. The method allows you to make a differential diagnosis with pneumonia, rib fracture, pleurisy and other pathologies of the lungs.
Lung scintigraphy. A method that allows you to make a correct diagnosis with high accuracy, but the clinic must have a gamma camera.
duplex scanning. This method is highly informative, but when obtaining normal results of the study, pulmonary vein thrombosis still cannot be ruled out.
D-dimer test. It takes about 4 hours to interpret the data, which often becomes critical for patients.
Angiopulmonography of the lungs, which allows you to specify the location of the thrombus. This method can be called safe and most often used for suspected pulmonary thrombosis. However, not all clinics have the equipment needed to conduct this study. In addition, angiopulmonography is an invasive and expensive procedure.
Phlebography of veins with the use of contrast. This is an expensive and painful type of research, which refers to invasive techniques.
Blood sampling for biochemical analysis.
So, of all the methods listed, only angiopulmonography and scintigraphy can accurately diagnose. The rest of the studies are ancillary.
Differential diagnosis is carried out with pneumothorax, infringement of diaphragmatic hernia, tumors that compress the pulmonary vein.
Treatment of pulmonary vein thrombosis
To begin with, you should understand that you cannot do anything at home, in case of pulmonary vein thrombosis, you should immediately call an ambulance.
The patient is urgently hospitalized and placed in the intensive care unit. All activities designed to normalize the blood supply to the lung tissue are carried out there. Doctors achieve unloading of a small circle of blood circulation. Additionally, bronchodilators, cardiac glycosides are administered, and oxygen therapy is performed.
With a submassive thrombus, a pulmonary vein catheterization is performed, the thrombus is divided into fragments using an endovascular technique, and drugs are directly applied to it, aimed at dissolving it.
Surgical intervention
The indication for emergency embolectomy is the presence of a thrombus in the pulmonary trunk or its main branches. If a patient has a severe degree of impaired lung perfusion, then the survival rate of such patients even after the operation remains low (no more than 12%). However, embolectomy without prior diagnosis is the only chance to save life. Therefore, the surgeon should not miss it.
Contraindications for surgical intervention are: the presence of a malignant tumor of the 4th stage, as well as severe circulatory failure against the background of pathologies of the heart and blood vessels.
To prevent re-thrombosis of the pulmonary vein, a special cava filter is installed in the patient. It is administered either through the atrium, or the inferior vena cava is plicated with a mechanical suture. The procedure is carried out only after the performed ebolectomy. Cava filters can have a different design, which the doctor chooses at his own discretion.
Forecast
As a rule, pulmonary vein thrombosis does not cause any pronounced health problems if the patient survives after this complications. Although 17% of patients still develop stenosis of the main pulmonary trunk. This complication is called chronic pulmonary hypertension. It is accompanied by shortness of breath, which worries the patient even while he is at rest. This condition significantly worsens the prognosis for life. Most case histories in this case end in death within 3-4 years.
Prevention of pulmonary vein thrombosis
In the prevention of pulmonary vein thrombosis, people over 40 years of age, patients who have had a heart attack or stroke, and obese patients need it. It is also indicated for people who have a history of deep vein thrombosis of the lower extremities or pulmonary vein thrombosis.
To prevent a blood clot from entering the lungs, it is necessary to adhere to the following recommendations:
Regularly undergo ultrasound of the veins of the lower extremities.
Wear elastic stockings.
Take heparin as directed by your doctor.
Do not refuse to set up a cava filter.
Timely treat thrombophlebitis.
Pulmonary thrombosis is a serious pathology that requires emergency medical care. But even in this case, it is impossible to guarantee the absence of a lethal outcome or disability. Therefore, it is necessary to take into account all the risk factors leading to this condition and strive to prevent them.
[Video] Cardiovascular surgeon, phlebologist Abasov M. M. – Products that thin blood clots: