CTICasesPulmonary Vein Stent Stenosis with Slow-Flow Mimicking Pulmonary Embolism
Imaging findings
In a patient with prior stents placed in the left superior and inferior pulmonary veins after complications of an atrial fibrillation ablation, serial early-phase CT pulmonary angiograms over several years repeatedly show ill-defined, smoke-like low attenuation confined to the left upper lobe pulmonary artery branches, corresponding to a severely stenotic or occluded left superior pulmonary vein stent while the inferior stent remains patent.
Key takeaways
This early-scanning "smoke" pattern localized downstream of a stenotic pulmonary vein stent represents slow flow from outflow obstruction and regional venous congestion, not true pulmonary embolism -- outside-hospital scans had been misread as PE; recognizing the vein stent stenosis and the early timing of the scan avoids over-diagnosing embolic disease, and delayed-phase imaging can confirm the slow-flow explanation.
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