Venous phase contrast-enhanced computed tomography facilitates the detection of pulmonary venous tumor thrombus

A 64-year-old woman, with a history of hepatocellular carcinoma, developed recurrent metastatic lung nodules after lung metastasectomy 10 years ago. Computed tomography (CT) revealed tumors in the right middle, and left lower lobes. We planned a right middle lobectomy. Before operating, a contrast-enhanced CT in the pulmonary venous phase revealed a tumor in the pulmonary vein resembling a thrombus, indicating that the CT failed to facilitate accurate diagnosis. Following venous clamping and incision, the intravenous polypoid mass was surgically removed. As contrast-enhanced CT focuses on pulmonary arterial phases and might not detect venous lesions, we highlight the usefulness of venous phase contrast-enhanced CT for detecting pulmonary venous tumor thrombosis. Large lung metastatic carcinomas with venous extension may embolize to distant organs. Therefore, venous phase contrast-enhancement is essential for preoperative assessments of large or persisting metastatic lung tumors.