Background. We study the clinical significance and management of pulmonary venous obstruction in
cancer patients. Methods. We conducted a prospective cohort study to characterize the syndrome that we term "pulmonary vein obstruction syndrome" (PVOS) between January 2005 and March 2014. The criteria for inclusion were (1) episodes of
shortness of breath; (2) chest X-ray showing abnormal pulmonary hilum shadow with or without presence of
pulmonary edema and/or
pleural effusion; (3) CT scan demonstrating pulmonary vein
thrombosis/
tumor with or without
tumor around the vein. Results. Two hundred and twenty-two patients developed PVOS.
Shortness of breath was the main symptom, which was aggravated by
chemotherapy in 28 (13%), and medical/
surgical procedures in 21 (9%) and showed diurnal change in intensity in 32 (14%). Chest X-rays all revealed abnormal pulmonary hilum shadows and presence of
pulmonary edema in 194 (87%) and
pleural effusion in 192 (86%). CT scans all showed pulmonary vein
thrombosis/
tumor (100%) and surrounding the pulmonary veins by
tumor lesions in 140 patients (63%). PVOS was treated with
low molecular weight heparin in combination with
dexamethasone, and 66% of patients got clinical/image improvement. Conclusion. Physicians should be alert to PVOS when
shortness of breath occurs and chest X-ray reveals abnormal pulmonary hilum shadows.