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Weekly Chest CasesArchive of Old Cases

Case No : 1302 Date 2022-10-05

  • Courtesy of Suyon Chang / Seoul St. Mary’s Hospital
  • Age/Sex 56 / M
  • Chief Complaintblood-tinged sputum (2 weeks ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary vein stenosis after ablation therapy for arrhythmia
Radiologic Findings
Fig 1-3. Chest CT shows peripheral consolidations, interlobular septal thickening, and parenchymal bands in the basal segments of right lower lobe.
Fig 4-5. CT scans reveals severe stenosis of the right inferior pulmonary vein.
Brief Review
Acquired pulmonary vein stenosis is most often seen after radiofrequency ablation for atrial fibrillation, occurring in up to 3%–8% of patients, although rates have been declining in recent years. These stenoses can be either focal or diffuse. Clinical symptoms of pulmonary vein stenosis are generally nonspecific and include cough, dyspnea, chest pain, hemoptysis, or recurrent respiratory infections. The chest radiographs of patients with pulmonary vein stenosis after radiofrequency ablation can be normal or can show pulmonary opacities that represent edema or venous infarctions, with or without pleural effusion. Contrast-enhanced CT can enable the diagnosis by directly depicting the stenosis and other associated features, such as pulmonary parenchymal septal thickening caused by localized pulmonary venous hypertension, peripheral opacities caused by infarctions, and increased attenuation of mediastinal fat adjacent to the stenosis, a finding resulting from inflammation and mediastinal fibrosis.
References
1. Learning from the Pulmonary Veins. RadioGraphics 2013;33:999-1022.
2. Comprehensive cross-sectional imaging of the pulmonary veins. RadioGraphics 2017;37:1928-1954.
Keywords
Pulmonary vein stenosis after ablation therapy,

No. of Applicants : 78

▶ Correct Answer : 29/78,  37.2%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - , Japan KYOKO NAGAI
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Osaka University , Japan AKINORI HATA
  • - Osaka Metropolitan University , Japan HIROTAKA TAKITA
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KENTARO KOTANI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - , Japan SHUNJIRO NOGUCHI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan RYO UEMURA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 3/78,  3.8%
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 14/78,  17.9%
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - Other , Korea (South) SEONGSU KANG
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , India JAHNAVI GADUPTI
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Other , Korea (South) KYU-CHONG LEE
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
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