Imaging of Acquired Pulmonary Venous Disease

Acquired pulmonary venous disease is predominantly detected on postablation imaging for atrial fibrillation, but may also be encountered incidentally or during evaluation for acute cardiopulmonary events. These entities require a high index of suspicion, as they involve subtle findings in an often-overlooked region. Moreover, recognition of associated findings may be particularly difficult on nongated imaging, which is prone to artifacts. Cardiac-gated CT and magnetic resonance imaging remain the primary imaging modalities, though echocardiography and diagnostic catheterization may contribute to the diagnosis in select cases. This review outlines key acquired pulmonary venous abnormalities, including pulmonary vein stenosis, pulmonary vein thrombosis, tumor invasion of the pulmonary vein, and intrapulmonary venous collateralization ("meandering pulmonary vein"). For each, we review relevant pathophysiology, imaging features, and clinical implications. The objective is to highlight key imaging features and potential challenges to avoid misdiagnosis and guide appropriate management across clinical scenarios.