Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation
Image Findings With Multiphasic Pulmonary Magnetic Resonance Angiography
A 53-year-old man was admitted with productive cough, chest pain, and hemoptysis. Eight months earlier, he had undergone radiofrequency ablation for atrial fibrillation originating from the right upper and both left pulmonary veins. Computed tomography demonstrated bronchopneumonic infiltrates in both upper lobes (Figure 1). A perfusion scintigram, performed to exclude pulmonary embolism, showed hypoperfusion of both upper lobes, despite a normal ventilation scintigram (Figure 2). Catheter angiography showed hypoperfusion of the upper lobes and no pathology of the pulmonary arteries (Figure 3). In the venous phase, both upper pulmonary veins were not visible (Figure 4). To achieve discrimination of the arterial and venous lung vessels, a time-resolved multiphasic pulmonary magnetic resonance angiography (MRA) was performed. Despite a lower spatial resolution, MRA was able to visualize both upper pulmonary veins with high-grade stenoses. On the basis of these findings, recanalization therapy of the pulmonary veins was planned.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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