Pulmonary vein occlusion: A delayed complication following radiofrequency ablation for atrial fibrillation

Figures

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  Fig. 1. Portable chest X-ray acquired at the time of presentation shows ill-defined opacity in the peripheral left lung (arrows), and no evidence of pleural effusion, or pneumothorax.

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  Fig. 2. A: Axial image pulmonary CT angiogram in lung window reveals two pulmonary infarcts (arrows) in the left upper lobe, the largest with the “ground glass halo” sign. Prominent mediastinal nodes (*) are also noted. B: Left inferior pulmonary vein occlusion - CT Pulmonary angiogram, MIP double oblique reformat shows that the trajectory of the vein is completely thrombosed (arrow). A peripheral infarct in the pathway of the vein is be seen (*). On the right, the partially imaged distal right pulmonary artery (RPA) and a portion of the patent right inferior pulmonary vein (RIPV) are identified. C: Left superior pulmonary vein occlusion - CT Pulmonary angiogram double oblique MIP reformat shows tapering of the contrast column at the left atrial junction and complete lack of contrast opacification of the trajectory of the vein (long arrows). Note peripheral infarcts in the territory of the occluded veins (short thick arrows). The right inferior pulmonary vein is patent (RIPV). Mildly reactive prominent left hilar nodes (*) are also present.

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  Fig. 3. Multiple spot views from the lung perfusion scan acquired after the intravenous administration of 4.0 mCi of Tc-99m MAA. Ventilation images were not acquired due to COVID-19 (Corona Virus Disease) precautions. Complete absence of perfusion is seen in the left lung which is explained by the occlusion of both pulmonary veins seen on the CT and concordant with the hyperemia seen on the chest x-ray. Normal perfusion is seen in the right lung with no perfusion defects.

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  Fig. 4. PA and lateral views (A and B respectively) of the chest acquired about two months after placement of pulmonary venous stents. The initial bilateral pulmonary vein ablation was performed in June 2019, patient was diagnosed with left sided pulmonary vein occlusion in March 2021, and the pulmonary venous stents were placed in April 2021. There has been interval resolution of the previously seen opacity in the peripheral left lung (Fig. 1) and presence of left sided pulmonary venous stents (arrows).