CTICasesPulmonary Vein Occlusion post Radiofrequency Ablation for Atrial Fibrillation
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Imaging findings
Initial CT shows small ground glass attenuating nodules in the upper lobe. Follow-up CT shows progressive, more diffuse ground glass opacities and focal consolidations, particularly in the lower lung zones, with a small left pleural effusion. Crucially, evaluation of pulmonary veins reveals progressive narrowing and eventual complete occlusion of multiple pulmonary veins, with only the right inferior pulmonary vein showing partial patency with some narrowing near its origin. A perfusion scan shows drastically reduced perfusion, mostly in the right lower lung. Angiogram confirms severe occlusion and increased resistance, with contrast medium spilling over into the right lung. There was also subtle wall thickening of the left main pulmonary artery and bronchial walls, suggesting congestion.
Key takeaways
Radiofrequency ablation for atrial fibrillation can cause severe complications, including pulmonary vein occlusion, which can lead to severe pulmonary hypertension. This can manifest with symptoms like hemoptysis, hemorrhagic edema, and progressive dyspnea. Imaging findings include ground glass opacities and consolidation due to hemorrhagic edema, and dramatic narrowing or complete occlusion of pulmonary veins. This iatrogenic complication can be highly detrimental, leading to severe VQ mismatch, pulmonary hypertension, and a poor prognosis, often requiring complex surgical interventions that may not be successful.
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