Edoxaban Resolved a Left Atrial Thrombus Intruding From the Right Lower Pulmonary Vein and Increased Cerebral Blood Flow: A Case Report

Pulmonary vein thrombosis (PVT) is thought to be rare; however, since 2012, the author has used 64- or 80-slice multidetector computed tomography (64- or 80-MDCT) to describe several cases of PVT. Some reports have involved the use of transesophageal echocardiography (TEE) to characterize PVT. Notably, the mechanism of how edoxaban affects thrombi in the pulmonary vein and left atrium and cerebral blood flow is poorly understood. An 85-year-old female with hypertension had a thrombus in her right lower pulmonary vein (RLPV) that intruded into the left atrium and exhibited snake-like characteristics when examined using TEE. The left atrium portion of the thrombus could be accurately imaged via TEE but not via 80-MDCT because it was thin and moved periodically. After six months of edoxaban treatment, the thrombus in the left atrium disappeared, as demonstrated by TEE, and cerebral blood flow increased, as measured by brain perfusion single-photon emission computed tomography (SPECT). Blood flow and a moving thrombus in the heart can be evaluated using TEE. Assessments via 80-MDCT alone may underestimate the incidence of a thrombus. Edoxaban ameliorated cerebral blood flow after six months of treatment, as measured via brain perfusion SPECT. Of note, treatment might reduce morbidity and prevent complications.