Idiopathic pulmonary vein thrombosis: clot picks vein instead of artery

Pulmonary vein thrombosis (PVT) is an uncommon disease with a very similar clinical presentation as pulmonary artery embolism. We present a case of a 53 year old female patient who presented with chest pain and shortness of breath and was later found to have pulmonary vein thrombosis. The diagnoses was established with a CT scan of chest which showed a filling defect in a right segmental pulmonary vein. Patient was started on heparin drip and later discharged on oral apixiban. Three month later, CT scan showed resolution of thrombus. PVT presents with non-specific symptoms which can be easily mistaken for pulmonary artery embolism. While investigating a patient for cryptogenic stroke, diagnoses of PVT should always be considered. Diagnoses is made via CT pulmonary angiogram or magnetic resonance angiography. Echocardiography also aids in confirming a diagnosis. Treatment is similar to pulmonary arterial embolism with systemic anticoagulants.