Pulmonary vein stump: A left atrial cardioembolic source

Authors

Austin Deets, Advocate Health - MidwestFollow
Ali Ali, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Nour Ghosoun, Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
Daniel Nelson, Advocate Health - MidwestFollow
Matthew Peters, Advocate Health - MidwestFollow
Atul Bhatia, Advocate Health - MidwestFollow

Recommended Citation

Deets A, Ali A, Ghosoun N, Nelson D, Peters M, Bhatia A. Pulmonary Vein Stump: A Left Atrial Cardioembolic Source. JACC Case Rep. 2025;30(15):103699. doi:10.1016/j.jaccas.2025.103699

Affiliations

Aurora Sinai/Aurora St. Luke's Medical Centers

Abstract

Background:The left atrial appendage (LAA) is the most common nidus for thrombus formation in atrial arrythmias.

Case summary:We present a case of acute limb ischemia initially thought to be embolic due to LAA thrombus from atrial flutter. Transesophageal echocardiography before direct current cardioversion demonstrated a LAA without thrombus and favorable filling velocities. However, thrombus was discovered in the postsurgical pulmonary vein stump.

Discussion:Pulmonary vein stumps are becoming recognized as a common source of intracardiac thrombus after lobectomy.

Take-home message:Performing a comprehensive transesophageal echocardiography before direct current cardioversion is paramount to avoid missing thrombi outside the LAA, especially in at-risk populations.

Type

Article

PubMed ID

40541361