Thrombus in the lungs: pulmonary vein thrombosis - symptoms and treatment

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Thrombus in the lungs: pulmonary vein thrombosis - symptoms and treatment
Thrombus in the lungs: pulmonary vein thrombosis - symptoms and treatment
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Pulmonary vein thrombosis

Thrombosis of the pulmonary vein
Thrombosis of the pulmonary vein

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, 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.

On Earth every year, about 0.1% of people from the total population of the world die 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 within 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

Causes of pulmonary vein thrombosis
Causes of pulmonary vein thrombosis

A thrombus does not form in the pulmonary vein. It gets there with the blood flow from other locations, clogging the lumen of the vessel.

Therefore, the causes of pulmonary vein thrombosis can be considered:

  • The patient has such a pathology as deep vein thrombosis of the leg. The combination of deep and superficial vein thrombosis of the leg.
  • Thrombosis of the inferior vena cava and its branches.
  • Cardiopathologies: ischemic heart disease, rheumatism accompanied by stenosis, atrial fibrillation, hypertension, infectious endocarditis, cardiomyopathy, non-rheumatic myocarditis.
  • Generalized sepsis.
  • Cancerous 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.
  • AFS 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.
  • Injury 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.
  • Treatment with diuretics when too much medication is needed. 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.
  • Varicose veins. 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.
  • Impaired hemostasis.
  • Over 50 years of age 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. Particularly dangerous in this regard are operations performed on the respiratory and peritoneal organs.
  • Being sedentary.
  • Childbirth, which proceeded with various complications.
  • Taking hormonal drugs for contraception.
  • Erythremia.
  • Systemic lupus erythematosus.
  • Hereditary diseases, such as 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.

Survivability

A life-threatening condition occurs when an obstruction occurs 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 leads to 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 entered, the stronger the violations.

Depending on where exactly the blood clot 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 increases to 75%.
  • If the thrombus stopped in the lobar and segmental branches, then the death of patients occurs in 6% of cases.
  • When blockage of small pulmonary branches, death is almost always avoided.

Pulmonary vein thrombosis symptoms

Symptoms of pulmonary vein thrombosis
Symptoms of pulmonary vein thrombosis

The symptoms of pulmonary vein thrombosis are varied. They depend on how extensive the lesion is, what the general he alth 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 the 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.
  • Feverish 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 Common Symptoms

In order to increase the likelihood of a correct diagnosis and save 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.
  • 54% of people suffer from suffocation.
  • More than 50% of patients develop a pulmonary infarction, which is expressed by chest pain, shortness of breath, bloody cough, wheezing in the lungs.

Forms of thrombosis

Depending on the course of the disease, there are three forms:

  • Fulminant 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.
  • 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 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 a fatal outcome is likely.
  • Chronic form, when the patient has symptoms of heart and lung failure, which gradually increase in intensity.

Complications of pulmonary vein thrombosis

Complications of pulmonary vein thrombosis
Complications of pulmonary vein thrombosis

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 care for their disease, the less the risk that he will develop severe complications.

The main pathological conditions that are provoked by pulmonary thrombosis include:

  • Infarction of the lung. A heart attack develops 2-3 days after 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 lung 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.
  • Inflammation of the lungs.
  • 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

Blood sampling
Blood sampling

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 he alth, 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, qualitative assessment of risk factors for the presence of pulmonary thrombosis in the patient.
  • Study 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.
  • cardiac ECG over time. The procedure is required to differentiate between 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 establishing.
  • X-ray of the lungs. 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 the correct diagnosis with high accuracy, but the clinic must have a gamma camera.
  • Duplex scanning. This method is highly informative, but with normal results, pulmonary vein thrombosis cannot be ruled out.
  • D-dimer test. It takes about 4 hours to interpret the data, which is often critical for patients.
  • Angiopulmonography of the lungs, which allows you to clarify the location of the blood clot. 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, pulmonary angiography is an invasive and expensive procedure.
  • Plebography of veins using contrast. This is an expensive and painful type of study that belongs to invasive techniques.
  • Blood sampling for biochemical analysis.

So, of all these methods, only angiopulmonography and scintigraphy can accurately diagnose. The rest of the research is ancillary.

Differential diagnosis is carried out with pneumothorax, strangulated diaphragmatic hernia, tumors compressing the pulmonary vein.

Pulmonary vein thrombosis treatment

Treatment of pulmonary vein thrombosis
Treatment of pulmonary vein thrombosis

First, you should understand that there is nothing you can do 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.

In case of 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 to dissolve it.

Surgery

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, the patient is fitted with a special cava filter. 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 significant he alth problems if the patient survives after 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

Prevention of pulmonary vein thrombosis
Prevention of pulmonary vein thrombosis

Pulmonary vein thrombosis prevention needs people over 40 years old, patients who have had a heart attack or stroke, patients with obesity. 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, you must 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.
  • Don't skip the 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.

Cardiovascular surgeon, phlebologist Abasov M. M. - Products that thin blood clots:

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