Significant Pulmonary Vein Stenosis

History

Following successful RFCA a 51-year-old female was presented to CT for exclusion of pulmonary vein stenosis. The patient was clinically asymptomatic.

Question

Presence of post-interventional pulmonary vein stenosis or exclusion of further complications.

Diagnosis / Differential diagnosis

• Post-procedural 70% high grade stenosis of the proximal upper left pulmonary vein.
• No evidence of further post-procedural complications, including arterial thrombi.
• Separate ostium for the right middle lobe vein.

Findings

The epicardial volume renderings reveal separate ostia for upper, middle (arrow) and lower lobe veins on the right side. Axial and parasagittal MPRs reveal a high grade stenosis of the upper left pulmonary vein.

Comments

CT proves to be a reliable tool for detection of post-interventional complications such as stenosis of pulmonary veins.

[1] Epicardial VR of the left atrium. The arrow hints at a variant vein on the right side, notably an additional ostium for the middle lobe vein (see arrow).	[2] Axial MPR showing a high-grade stenosis of the upper left pulmonary vein (arrow).
[3] MPR angulated on the main axis of the upper left pulmonary vein (arrow).	[4] Parasagittal MPR, orthogonal to the main axis of the vessel (see arrow).

Authors: Brodoefel H, Heuschmid M, Kopp AF

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