ATRIAL ANASTOMOTIC THROMBUS CAUSES NEUROLOGIC DEFICITS IN A LUNG-TRANSPLANT RECIPIENT

Pulmonary thrombus formation in the region of atrial anastomosis follo wing lung transplantation has been reported by several authors. Such p atients typically present immediately after surgery with significant h emodynamic compromise causing pulmonary edema and hypoxemia. We descri be a patient who presented with bilateral neurologic deficits 4 and 6 weeks after lung transplantation. Despite a normal transthoracic echoc ardiogram, transesophageal echocardiography (TEE) detected a large lef t atrial thrombus adherent to the atrial anastomosis. This thrombus wa s treated with intravenous heparin and subsequently warfarin. After 3 weeks, a repeat TEE demonstrated complete resolution of the lesion. Th is case demonstrates that postoperative left atrial and pulmonary veno us thrombi may provide the basis for serious patient morbidity without hemodynamic or radiographic clues to their presence, that TEE is supe rior to transthoracic echocardiography for detecting left atrial throm bi, and that such lesions can respond to medical management alone.