[Pulmonary Vein Thrombus and Multiple Arterial Thromboembolism after Left Upper Lobectomy-A Case Report]

A woman in her 70s underwent left upper lobectomy with ND2a‒1 dissection for suspected lung cancer(cT1cN0M0, stage ⅠA3)and was discharged on postoperative day(POD)4. On POD 12, she developed watery diarrhea, nausea, vomiting, abdominal pain, mild lower back pain, and hematochezia. Stool cultures were negative. Gastroenteritis was diagnosed, and the symptoms resolved with fasting and intravenous hydration. She was discharged again on POD 21. However, that night, she returned to the emergency department with a fever of 38℃. Laboratory examinations showed elevated inflammatory markers and lactate dehydrogenase(LDH). Contrast‒enhanced computed tomography(CT)showed thrombi in the left pulmonary vein stump, distal left subclavian artery, and superior mesenteric artery, along with left renal infarction. Anticoagulation therapy was started, and follow‒up CT on POD 34 showed that the pulmonary vein stump thrombus was smaller, and contrast enhancement of the left kidney had improved. Anticoagulant therapy is currently ongoing. This case demonstrates that left upper lobectomy, a known risk factor for thromboembolism, can lead to atypical presentations such as gastrointestinal symptoms and fever. Mesenteric ischemia and renal infarction may mimic common postoperative conditions. Clinicians should maintain a high level of suspicion for thromboembolic complications, even when symptoms involve non‒thoracic organs.