CTICasesSarcoidosis-Induced Pulmonary Vein Stenosis Treated with Endovascular Stenting
Imaging findings
Contrast-enhanced CT of the chest demonstrates asymmetric, amorphous, and ill-defined mediastinal soft tissue encasing the pulmonary veins. This soft tissue mass has caused severe, critical narrowing of the pulmonary veins, associated with ipsilateral interlobular septal thickening, ground-glass opacity representing localized pulmonary venous congestion/edema, and a pleural effusion. Follow-up CT demonstrates subsequent endovascular stenting of the stenosed pulmonary veins, which shows patent stents but persistent, severe regional narrowing and venous congestion.
Key takeaways
Although pulmonary vein stenosis is most commonly an iatrogenic complication of radiofrequency ablation for atrial fibrillation, it can rarely be caused by extrinsic compression from fibrosing mediastinitis, histoplasmosis, or sarcoidosis. In sarcoidosis, the mediastinal lymphadenopathy and associated fibrotic response can become amorphous, infiltrative, and confluent, mimicking fibrosing mediastinitis and critically compressing pulmonary veins or arteries. Treatment of this complication is challenging and may require endovascular stenting, although restenosis remains a major limitation.
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