A case of multi-organ thromboembolism after left upper lobectomy of the lung

Abstract

A 71-year-old woman with a left upper lobe tumor of the lung was referred to us for surgical treatment. Thoracoscopic left upper lobectomy of the lung was performed without any intraoperative complication. The pathological diagnosis was typical carcinoid of the lung. Anticoagulant therapy (intravenous heparin) was initiated on the fifth postoperative day because paroxysmal atrial fibrillation appeared intermittently from the operative day to the third postoperative day, and it reappeared from the fifth to the eighth postoperative day. The patient developed sudden-onset abdominal pain at 12 days after surgery. Contrast computed tomography revealed an intra-atrial thrombus adhering to the stump of the left upper pulmonary vein. Infarction of the spleen and bilateral kidneys and thromboembolism of the superior mesenteric artery were also detected. Brain MRI revealed a cerebellar infarction. Intravenous heparin therapy was continued, with the aim of prolonging the partial prothrombin time, and oral warfarin was administered to improve anti-coagulation. The patient was discharged from the hospital a month after surgery while continuing to receive oral warfarin. She has been doing well without any sign of thromboembolism since then. For those with a high risk of thromboembolism (left upper lobectomy, obesity, high age, etc. ), post-operative contrast-enhanced CT should be readily performed, along with initiating appropriate anti-coagulation therapy if indicated.