Korean J Radiol.  2015 Aug;16(4):942-946. 10.3348/kjr.2015.16.4.942.

Lung Infarction due to Pulmonary Vein Stenosis after Ablation Therapy for Atrial Fibrillation Misdiagnosed as Organizing Pneumonia: Sequential Changes on CT in Two Cases

• Kwon MR
• Lee HY
• Cho JH
• Um SW

• KMID: 2155571
• DOI: http://doi.org/10.3348/kjr.2015.16.4.942

Abstract

Pulmonary vein (PV) stenosis is a complication of ablation therapy for arrhythmias. We report two cases with chronic lung parenchymal abnormalities showing no improvement and waxing and waning features, which were initially diagnosed as nonspecific pneumonias, and finally confirmed as PV stenosis. When a patient presents for nonspecific respiratory symptoms without evidence of infection after ablation therapy and image findings show chronic and repetitive parenchymal abnormalities confined in localized portion, the possibility of PV stenosis should be considered.

Keyword

Pulmonary venous infarction; Pulmonary vein stenosis; Radiofrequency ablation; Complications

MeSH Terms

Atrial Fibrillation/surgery
Catheter Ablation/*adverse effects/methods
Constriction, Pathologic/diagnosis/*radiography
*Diagnostic Errors
Female
Humans
Lung/surgery
Male
Middle Aged
Pneumonia/diagnosis
Pulmonary Infarction/pathology/*radiography
Pulmonary Veins/physiopathology/radiography
Tomography, X-Ray Computed/adverse effects
Vascular Diseases/physiopathology

Figure

• 

  Fig. 1 Serial imaging findings over 21-month period of 49-year-old man with history of ablation therapy. A, B. On 16-month post-ablation non-enhanced CT (lung windows), multiple nodular lesions (arrowheads) and linear parenchymal band (arrows) in left upper lobe are detected. C, D. On 18-month post-ablation follow-up CT, multiple nodular lesions are seen to disappear, though new nodules (arrows) are visible in lingular division of left upper lobe. Interstitial septal thickening (arrowheads) is prominent. E, F. On 21-month post-ablation follow-up CT, nodular lesions had disappeared but multiple additional nodules (arrowheads) are noted in left upper lobe. G. Pre-ablation cardiac CT (mediastinal windows) shows normal left superior pulmonary vein (arrows). H. On 18-month follow-up non-enhanced CT image, there is no significant stenosis of left superior pulmonary vein (arrows). I, J. But on 21-month follow-up axial (I) and coronal (J) contrast-enhanced CT images show severe stenosis (arrowheads at stenosis site) of left superior pulmonary vein (arrows).

• 

  Fig. 2 Serial imaging findings over 19-month period of 50-year-old woman with history of ablation therapy. A, B. On seven-month post-ablation non-enhanced CT (lung windows), several ground-glass opacity nodular lesions (arrow) are identified in superior segment of left lower lobe with small left pleural effusion (arrowheads). C, D. On 19-month post-ablation follow-up CT, nodular lesions and pleural effusion are seen to resolve, but new nodules in left lower lobe (arrows) are noted. Also, interstitial septal thickening in left lower lobe (black arrowhead) are newly detected. E, F. On 19-month follow-up contrast-enhanced CT images (mediastinal windows, F) show severe stenosis of left inferior pulmonary vein compared with pre-ablation cardiac CT (E, arrows at origin site of left inferior pulmonary vein). G. On ventilation/perfusion lung scan, total perfusion deficit of left lower lobe is detected.

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