Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative
complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial
embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject
from the limited literature available, and suggest potential strategies to anticipate, detect and manage this
entity.
A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via
repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well
post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and
paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left
superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic
anticoagulation, and made an excellent recovery thereafter.
The aetiology of this complication has been documented in some case reports, but it is not explored further
in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy
surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be
related to the relatively longer LSPV stump and stasis of blood in the stump [4].
A case of multi-organ thromboembolism after left upper lobectomy of the lung
