Pulmonary vein stenosis after atrial fibrillation ablation: diagnosis on non-contrast chest computed tomography, a case report

Estenosis de vena pulmonar después de la ablación por fibrilación auricular: diagnostico desde la tomografía de tórax simple, reporte de caso

Abstract

Pulmonary vein stenosis following pulmonary vein ablation for rhythm control in atrial fibrillation is a complication described in the literature, with a decreased incidence in recent years due to therapy optimization. Based on the presence of respiratory symptoms associated with radiological findings, it is suspected that changes in the lung parenchyma are secondary to venous congestion caused by pulmonary vein stenosis. However, clinical symptoms and pulmonary imaging alone are nonspecific; the history of pulmonary vein ablation is crucial for the diagnostic approach.

We present the case of a 72-year-old man who underwent pulmonary vein ablation as a strategy for rhythm control of his atrial fibrillation. Eleven months later, he developed respiratory symptoms and sought medical attention, initially suspected of having a pulmonary infection. However, in a multidisciplinary assessment considering the procedural history, alongside the described symptoms and tomographic findings in the lung parenchyma, left pulmonary vein stenosis was suspected, a diagnosis later confirmed by chest angiotomography. This case exemplifies the necessity of analyzing the clinical presentation with radiological findings and prior medical history for a timely diagnosis.