Key result
High-grade left pulmonary vein stenosis caused by prior pulmonary vein isolation can present as a pronounced mismatched perfusion deficit on ventilation/perfusion SPECT/CT, mimicking pulmonary embolism.
Case Report (n=1)
Pulmonary vein stenosis should be considered as a differential diagnosis for mismatched perfusion deficits on V/Q SPECT/CT in dyspneic patients with a history of pulmonary vein isolation.
A 58-year-old man with progressive dyspnea and recurrent extensive left-sided pleural effusion underwent pulmonary ventilation/perfusion SPECT/CT, which showed a pronounced mismatched perfusion deficit of the entire, normally ventilated left lung. As unilateral perfusion deficits of an entire lobe are generally not due to pulmonary embolism, further CT angiography and cardiac MRI were conducted. These examinations revealed high-grade left pulmonary vein stenosis (PVS) caused by pulmonary vein isolation performed for atrial fibrillation 3 and 4 years earlier. Thus, in addition to, for example, neoplastic processes or pulmonary congenital vascular abnormalities, PVS must be considered as a differential diagnosis and possible pitfall in ventilation/perfusion SPECT/CT in dyspneic patients with prior pulmonary vein isolation.
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Kind et al. (2020) conducted a case report in Pulmonary vein stenosis (n=1). Ventilation/perfusion SPECT/CT was evaluated on Diagnosis of high-grade left pulmonary vein stenosis. High-grade left pulmonary vein stenosis caused by prior pulmonary vein isolation can present as a pronounced mismatched perfusion deficit on ventilation/perfusion SPECT/CT, mimicking pulmonary embolism.
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