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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 - Korean J Radiol (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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).
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Figure 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).

Mentions: Sixteen months later, the patient revisited the hospital because of a small amount of recurrent hemoptysis and left-sided chest pain. Physical examination and laboratory studies were within normal limits. Chest radiography showed a focal linear opacity with consolidation in the left upper lung zone and non-enhanced CT revealed ill-defined nodular lesions and a parenchymal band in the left upper lobe (Fig. 1A, B). A definitive diagnosis was not made at that time since the patient had no evidence of infection and CT findings did not correlate with the typical presentation of pneumonia, interstitial lung disease, or vasculitis. As a result, the patient was diagnosed with organizing pneumonia with plans for a follow-up CT study two months later.


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 - Korean J Radiol (2015)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499562&req=5

Figure 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).
Mentions: Sixteen months later, the patient revisited the hospital because of a small amount of recurrent hemoptysis and left-sided chest pain. Physical examination and laboratory studies were within normal limits. Chest radiography showed a focal linear opacity with consolidation in the left upper lung zone and non-enhanced CT revealed ill-defined nodular lesions and a parenchymal band in the left upper lobe (Fig. 1A, B). A definitive diagnosis was not made at that time since the patient had no evidence of infection and CT findings did not correlate with the typical presentation of pneumonia, interstitial lung disease, or vasculitis. As a result, the patient was diagnosed with organizing pneumonia with plans for a follow-up CT study two months later.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

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.

No MeSH data available.


Related in: MedlinePlus