Tima Davidson MD, Presenter: Nothing to Disclose

Orly Goitein MD, Abstract Co-Author: Nothing to Disclose

Elinor Goshen, Abstract Co-Author: Nothing to Disclose

Michael Glikson MD, Abstract Co-Author: Nothing to Disclose

Chrystalleni milonas, Abstract Co-Author: Nothing to Disclose

Sivan Lieberman MD, Abstract Co-Author: Nothing to Disclose

Simona Ben Haim, Abstract Co-Author: Nothing to Disclose

Pulmonary vein stenosis (PVS) is a serious complication occurring in 1%-3% of radiofrequency catheter ablation procedures for treating atrial fibrillation. The lung parenchyma may suffer a significant insult when PVS is present. The purpose of this study is to describe the CT appearance of pulmonary parenchymal findings (PPF) in patients with PVS.

A clinical database of pulmonary vein ablation procedures (2006 – 2013) was reviewed for PVS cases. Retrospective analysis included reviewing the base line CT before the procedure, second CT for evaluating the clinical suspicion of PVS and follow up CT scans (total of 40 scans, between 4 days and 51 months). Studies were evaluated for the presence of PPF.

The study cohort included 8 patients (pts) (average age 47; 88% males). Four pts had occlusion of both left superior and inferior pulmonary veins (LSPV, LIPV), 3 pts had occlusion of LSPV and stenosis > 80% of the LIPV, and one pt had LIPV stenosis of 65%. Lower contrast opacification and "sluggish flow", mimicking pulmonary emboli, were demonstrated in the left pulmonary artery in pts with occlusion of both LSPV and LIPV (4/8). Pulmonary parenchymal findings (PPF) were documented in pts with stenosis > 80% (7/8); in both left lobes 5/7, in the left upper lobe 1/7 and in the left lower lobe 1/7. PPF included: peripheral extensive consolidations (7/7), ground glass opacities (7/7), peripheral interstitial thickening (7/7) and small left pleural effusion (5/7). In each of the seven pts, PPF were dynamic over time, demonstrating worsening (5/7), migration (6/7) or improvement (2/7), of the changes on the serial follow up scans. No pt showed complete resolution. PPF appeared as soon as 4 days following the ablation and persisted to up 51 months.

PPF were present in all pts with PVS > 80%. These changes were persistent and dynamic over time, tending to demonstrate gradual worsening .PPF can still be present a long time after the ablation procedure. Therefore, physicians should familiarize themselves with these findings in order to avoid erroneous diagnosis of pneumonia, lung cancer or pulmonary embolism in post ablation pts

Awareness to the possibility of persistent PPF related to a previous ablation procedure is of high importance. This could avoid incorrect interpretation which may lead to unnecessary intervention.

Davidson, T, Goitein, O, Goshen, E, Glikson, M, milonas, C, Lieberman, S, Ben Haim, S, Pulmonary Parenchymal Findings in Patients with Pulmonary Vein Stenosis following Radiofrequency Catheter Ablation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045655.html