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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 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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Figure 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.

Mentions: Seven months after the procedure, the patient began to experience chest discomfort. Non-enhanced CT showed ground-glass opacity nodular lesions in the left lower lobe with left pleural effusion (Fig. 2A, B). The patient was subsequently diagnosed with organizing pneumonia. However, one year later, the patient presented with hemoptysis and dyspnea. Transthoracic echocardiography showed no definite abnormality. A follow-up contrast-enhanced CT was done, which showed new nodular lesions and interstitial septal thickening in the left lower lobe (Fig. 2C, D). Comparing with pre-ablation cardiac CT (Fig. 2E), an occluded left inferior PV was newly noted (Fig. 2F). A ventilation/perfusion lung scan showed absent perfusion of the left lower lobe (Fig. 2G). Under the impression of left inferior PV stenosis with non-function of involved lung parenchyma, a left lower lobectomy was performed. Histopathologic examination showed intimal hyperplasia associated with hypertensive pulmonary vasculopathy and multifocal hemorrhagic infarction secondary to PV thrombosis.


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

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

Figure 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.
Mentions: Seven months after the procedure, the patient began to experience chest discomfort. Non-enhanced CT showed ground-glass opacity nodular lesions in the left lower lobe with left pleural effusion (Fig. 2A, B). The patient was subsequently diagnosed with organizing pneumonia. However, one year later, the patient presented with hemoptysis and dyspnea. Transthoracic echocardiography showed no definite abnormality. A follow-up contrast-enhanced CT was done, which showed new nodular lesions and interstitial septal thickening in the left lower lobe (Fig. 2C, D). Comparing with pre-ablation cardiac CT (Fig. 2E), an occluded left inferior PV was newly noted (Fig. 2F). A ventilation/perfusion lung scan showed absent perfusion of the left lower lobe (Fig. 2G). Under the impression of left inferior PV stenosis with non-function of involved lung parenchyma, a left lower lobectomy was performed. Histopathologic examination showed intimal hyperplasia associated with hypertensive pulmonary vasculopathy and multifocal hemorrhagic infarction secondary to PV thrombosis.

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