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Weekly Chest CasesArchive of Old Cases

Case No : 915 Date 2015-05-11

  • Courtesy of Sung Ho Hwang, Yu-Whan Oh, Soo-Youn Ham / Korea University Anam Hospital
  • Age/Sex 50 / F
  • Chief ComplaintSevere dyspnea and hemoptysis. She had a history of atrial fibrillation.
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pulmonary venous stenosis related to catheter ablation of atrial fibrillation
Radiologic Findings
Chest radiograph (Fig. 1) shows diffuse haziness and fine nodular opacities in the left lung field. Blunting of the left costophrenic angle suggests pleural effusion. Chest CT scan (Fig. 2) reveals a small consolidation and small patchy areas of ground-glass opacities with a mosaic perfusion appearance in the left lower lobe. Chest CT images (Fig 3) in the mediastinal window setting show engorged vessels and prominent interstitium along the proximal bronchovascular bundles in the left lower lobe.
Brief Review
Catheter ablation for electronic isolation of the pulmonary vein (PV) has been accepted as an effective strategy for refractory atrial fibrillation (AF). However, a prior study reported a 6% overall rate of major complications associated with AF catheter ablation procedures. Complications include death, stroke, cardiac tamponade, PV stenosis, and atrioesophageal fistula. Among the major complications related to catheter ablations, PV stenosis has been reported in 1.5% to 42.4% of patients after catheter ablation of AF. Current extraostial techniques using lower energy delivery result in an incidence of moderate to severe stenosis in less than 1.4%. In addition, as PV stenosis may cause lung parenchymal focal edema, veno-occlusive disease, parenchymal hemorrhage, venous thrombosis, and venous infarcts, PV balloon angioplasty and stenting has been used to treat symptomatic severe PV stenosis (arrow in Fig. 4).
References
1. Lee JY, Chon GR, Park JH, Kang BJ, Shim TS, Jo KW. Massive hemoptysis due to pulmonary vein stenosis following catheter ablation for atrial fibrillation. Respiratory care. 2015;60:e52-55
2. Matsuyama TA, Asano T, Inoue S, Kobayashi Y. Pathology in the late phase after extensive and ostial pulmonary vein ablation for atrial fibrillation: Findings in 2 postmortem cases. Heart rhythm : the official journal of the Heart Rhythm Society. 2015;12:425-429
Keywords
Vascular, Iatrogenic lung disease, Postoperative complication,

No. of Applicants : 96

▶ Correct Answer : 66/96,  68.8%
  • - university of montreal , Canada Andrei Gorgos I
  • - Kyoto University , Japan Akihiko Sakata
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Dong-A University Hospital , Korea (South) Won Jin Choi
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Chonnam Nationl University Radiology , Korea (South) juwon kim
  • - santosh hospital , India Pravin Mahadevappa
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - University of British Columbia , Canada Amr Ajlan
  • - Emory University Department of Radiology , United States Travis Henry
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Armed Force Seoul Hospital , Korea (South) Eui Jin Hwang
  • - Gimpo marine medical corps , Korea (South) Hyorin Kim
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Korea university , Korea (South) Kun Woo Kang
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - McGill , Canada ilan azuelos
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - SMG - SNU Boramae Medical Center , Korea (South) Ye Ra Choi
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Ajou University hospital , Korea (South) Hun Cho
  • - Niigata University , Japan Atsushi Uehara
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Chonnam national university hospital , Korea (South) Wongi Jeong
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - pamukkale university hospital , Turkey ergin karaman
  • - Wuhan Union Hospital , China Qiguang Cheng
  • - Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - CNUH , Korea (South) Noh Hoon
  • - Nasaret international hospital , Korea (South) Hee Seok Choi
  • - Asan , Korea (South) Sania ALBlushi
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - UZ Brussel , Belgium Abd Alla Fares
  • - CHU POITIERS , France SZTARK Guillaume
  • - CHRU Lille , France Julien Pagniez
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - 異⑸ , Korea (South) Yunhee Jang
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - IRSA La Rochelle , France Denis Chabassiere
  • - CHU Rennes , France Tanguy Libessart
  • - CHU Poitiers , France CHAN paul
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - VHS medical center , Korea (South) Keuntak Roh
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
▶ Correct Answer as Differential Diagnosis : 5/96,  5.2%
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - kyungpook national university , Korea (South) Chungeun Lim
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Okayama University Hospital , Japan Toshiyuki Komaki
▶ Semi-Correct Answer : 1/96,  1.0%
  • - �stanbul , Turkey Ayhan Yilmaz
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