Presentation
Presents with dyspnea and hemoptysis (Hb at 8.3g/dl). CT to rule out tumor. PH of atrial fibrillation.
Patient Data
Poor opacification of the left pulmonary arterial tree.
proximal pseudo-filling defect in the left pulmonary artery extending to all its branches, in keeping with pulmonary artery flow artifact (may mimic a pulmonary embolism, but the venous phase shows patency of the pulmonary artery)
The inferior and superior left pulmonary veins are not opacified
venous collateral pathways - venous varices
microcalcification around the pulmonary vein walls, suggestive of probable radiofrequency ablation sequelae
mild pleural effusion
regular thickening of the interlobular septa, with ground glass opacification, suggestive of pulmonary edema
left-sided regular and diffuse thickening of bronchovascular bundles
This CT was made 8 years ago, prior to the first radiofrequency ablation. It demonstrates normal left pulmonary veins.
Case Discussion
History of two radiofrequency ablations for atrial fibrillation (first RFA 8 years ago and second RFA 3 years ago), and the pulmonary vein occlusions are a recognized complication.
The differential diagnosis of pulmonary vein agenesis was excluded by the demonstration of normal pulmonary veins on the pre-ablation cardiac CT.
Pulmonary vein occlusion causes regional pulmonary hypertension with subsequent slow and turbulent flow in the left pulmonary artery, seen as a flow artifact.
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