Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
Department of Cardiology, Geneva University Hospital, Geneva, Switzerland.
BMJ Case Rep. 2022 Dec 7;15(12):e250896. doi: 10.1136/bcr-2022-250896.
A man in his 50s presented with persistent chest pain, haemoptysis, cough and dyspnoea 5 months after undergoing catheter ablation for atrial fibrillation (AF). Several chest CT scans suggested pneumonia. Despite adequate treatment for recurrent pneumonia, symptoms persisted. While reviewing the initial chest CT, a partial venous infarction of the left lower lobe associated with severe left inferior pulmonary vein stenosis (PVS) was diagnosed. Stenting of the left inferior pulmonary vein with a vascular bare metal stent was performed, guided by fluoroscopy and transoesophageal echocardiography. Dual antiplatelet therapy (aspirin/clopidogrel) was introduced for 3 months, followed by long-term aspirin monotherapy. The treatment resulted in relief of his symptoms and the resolution of pulmonary opacities on chest CT. Despite low frequency, AF ablation remains the most common cause of acquired PVS. As highlighted in this case, symptoms are not specific and include recurrent pulmonary infection with delayed management.
一名 50 多岁男性在接受心房颤动 (AF) 的导管消融术后 5 个月时出现持续性胸痛、咯血、咳嗽和呼吸困难。多次胸部 CT 扫描提示肺炎。尽管反复肺炎的治疗充分，但症状仍持续存在。在回顾最初的胸部 CT 时，诊断为左肺下叶部分静脉梗死，伴严重左下肺静脉狭窄 (PVS)。在透视和经食管超声心动图的引导下，对左下肺静脉进行血管裸金属支架置入术。引入双联抗血小板治疗（阿司匹林/氯吡格雷）3 个月，随后长期单独使用阿司匹林。治疗后患者症状缓解，胸部 CT 上肺部混浊度消失。尽管频率较低，但 AF 消融仍然是获得性 PVS 的最常见原因。正如本例所示，症状不具特异性，包括反复肺部感染伴延迟治疗。
