CTICasesPulmonary Vein Thrombosis After Redo Lung Transplant Causing Venous Congestion
Imaging findings
In a 45-year-old man about a week after a redo bilateral lung transplant, serial chest radiographs show persistent opacity confined to the left lower lobe that fails to clear despite improvement on the right, accompanied by hemoptysis. CT shows left lower lobe airway wall thickening, fissural and septal thickening, ground-glass opacity, and consolidation with abrupt cutoff of the left inferior pulmonary vein and a visible thrombus tail, while the left superior pulmonary vein remains patent.
Key takeaways
Unilateral, lobar ground-glass opacity and consolidation after lung transplant should prompt close evaluation of the pulmonary veins for thrombosis or stenotic anastomosis, especially in redo transplants where surgical adhesions can force separate, technically more difficult venous anastomoses; the operative report here confirmed thrombosis at the left inferior pulmonary vein anastomosis accounting for the venous congestion.
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