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Pulmonary Vein Stump: A Left Atrial Cardioembolic Source.

Austin Deets¹, Ali Ali², Nour Ghosoun³

¹Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA. Electronic address: https://twitter.com/DeetsAustin.

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Summary

Thrombus formation can occur outside the left atrial appendage (LAA) in pulmonary vein stumps after surgery. Comprehensive echocardiography is crucial to detect these thrombi before cardioversion, especially in high-risk patients.

Keywords:

atrial flutter cardioembolism computed tomography pulmonary vein stump thrombosis transesophageal echocardiography

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Area of Science:

Cardiology
Medical Imaging
Surgical Complications

Background:

The left atrial appendage (LAA) is a primary source of thrombus in atrial arrhythmias.
Identifying thrombus sources is critical for preventing embolic events.

Observation:

A case of acute limb ischemia was initially attributed to LAA thrombus.
Transesophageal echocardiography revealed no LAA thrombus but identified thrombus in a postsurgical pulmonary vein stump.

Findings:

Pulmonary vein stumps are an emerging source of intracardiac thrombus post-lobectomy.
This highlights the limitations of focusing solely on the LAA for thrombus detection.

Implications:

Comprehensive echocardiography before cardioversion is essential to identify thrombi in alternative locations.
This practice is vital for at-risk patient populations to prevent missed diagnoses and ensure effective treatment.