case_images: PMC6159190_01
case_images: Three months post-ablation follow-up cardiac CT scan: (a) Lung window shows normal pulmonary parenchyma. (b and c) 3D reconstruction of left atrium and mediastinal window enhanced CT axial section respectively show left upper pulmonary vein LSPV moderate stenosis (arrows).
case_images: bjrcr.20160091.g001.jpg
case_images: PMC6159190_01_bjrcr.20160091.g001.jpg
case_images: f1
case_images: AF. Ambulatory follow-up cardiac computed tomography (CT) angiogram was done 3 months following RFA and showed approximately 60% left superior PVS but no intervention was performed because the patient was asymptomatic and he was kept on oral anticoagulation (Figure 1).
case_images: (a and b) Non-enhanced chest CT scan: lung window (a) shows pleural-based parenchymal consolidation (curved arrow) associated with adjacent subtle ground glass attenuation and interlobular septal thickening (arrow head). Mediastinal window (b) shows left-sided minimal pleural effusion (thin arrow). These pulmonary findings are related to total LSPVO revealed by (c) 3D reconstruction of left atrium (asterisk), note other pulmonary veins patency. (d) Contrast-enhanced CT scan axial section depicts total occlusion of LSPV.
case_images: bjrcr.20160091.g002.jpg
case_images: PMC6159190_01_bjrcr.20160091.g002.jpg
case_images: f2
case_images: CT was done and showed increased parenchymal attenuation and multiple peripheral patchy consolidations in the apico-posterior and anterior segments of left upper lobe associated with minimal left pleural effusion (Figure 2a and b). Cryptogenic organizing pneumonia (COP), chronic eosinophilic pneumonia (CEP), fungal infection (pulmonary aspergillosis), lung cancer and primary pulmonary lymphoma were suggested as differential diagnosis and ultrasound-guided aspiration of the left-sided pleural effusion was carried out and the obtained specimen was fluid of serous nature. After that contrast-enhanced CT scan was performed with 3D reconstruction and manifested clearly an occluded left superior pulmonary vein (LSPV) (Figure 2c and d).