Lower pulmonary veins are likely to have a pulmonary vein thrombus

Pulmonary vein thrombosis (PVT) was hypothesized as rare. However, since 2014, I have published several cases of PVT in elderly patients with chest pain using 64-slice multidetector computed tomography [1–10]. In 2014, I reported that 61% (35 patients) of 57 elderly patients had PVT [9], suggesting that PVT is common in elderly patients with chest pain; however, the pulmonary vein that is likely to contain a thrombus is unknown. I reviewed the images of PVT from 26 of 35 patients with PVT. The mean age of the 26 patients was 74.1 ± 7.1 years (mean ± standard deviation) and the range was from 60 years to 93 years of age. Fourteen patients had a thrombus in the right lower pulmonary vein (RLPV), and 14 patients had a thrombus in the left lower pulmonary vein (LLPV). Five patients had a thrombus in the right middle pulmonary vein (RMPV), and five patients had a thrombus in the right upper pulmonary vein (RUPV). Nine patients had a thrombus in the left upper pulmonary vein (LUPV). A total of 47 thrombi were identified in 26 patients with PVT, and 15 patients had more than two pulmonary vein thrombi. The lower pulmonary veins had 28 thrombi (60%). The right and left lower pulmonary veins are likely to contain a pulmonary vein thrombus. The right pulmonary vein had 24 thrombi (51%). The right pulmonary vein (24) and left pulmonary vein (23) contain thrombi at a similar frequency. The ratio of pulmonary vein thrombus existence is RLPV = 3, RMPV = 1, RUPV = 1, LLPV = 3, and LUPV = 2 (Fig. 1).