CTICasesPulmonary Vein Stenosis Post-Ablation with Collaterals
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Imaging findings
A patient post-ablation for atrial fibrillation presented with shortness of breath. Imaging showed asymmetric septal line thickening, particularly in the left lower lobe. CT revealed severe stenosis at the origin of the inferior pulmonary vein and significant narrowing of the superior pulmonary vein. A radiograph demonstrated asymmetric interstitial Kerley B lines. Subsequent imaging showed in-stent stenosis of the left lower lobe stent with recurrent edema, and the development of venovenous collaterals draining the lower lobe into the unobstructed upper lobe pulmonary veins.
Key takeaways
This case highlights asymmetric pulmonary edema as a complication of pulmonary vein stenosis following atrial fibrillation ablation. Serial imaging effectively demonstrated the waxing and waning pattern of edema in the affected lobe. The unique finding was the development of venovenous collaterals, which served to bypass the obstructed pulmonary veins.
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