Case ReportPostradiofrequency ablation inflammatory pseudotumor associated with pulmonary venoocclusive disease: case report and review of the literature
Introduction
Radiofrequency ablation of pulmonary veins is an increasingly common therapeutic intervention for medically refractory atrial fibrillation that targets the proximal myocardial tissue beyond the pulmonary vein ostia [1]. Pulmonary vein stenosis and subsequent pulmonary venoocclusive disease are recognized but uncommon complications of this procedure [2]. Associated pulmonary inflammatory pseudotumor formation necessitating surgical resection has not been previously reported.
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Materials and methods
Two surgical resections from our institution were reviewed by light microscopy, one of pseudotumor formation with associated pulmonary vein stenosis (current case). A literature search was performed for the following terms: “histology,” “pathology,” and “histopathology” each with “pulmonary vein radiofrequency ablation atrial fibrillation.” Pathologic features of the Massachusetts General Hospital cases were compared with those in existing reports.
Index case clinical history
A 66-year-old man with chronic obstructive pulmonary disease and hypertension had refractory atrial fibrillation that required radiofrequency ablation. The left upper, left middle, and right upper pulmonary veins were isolated and ablated. The procedure was complicated by hemopericardium and cardiac tamponade requiring emergency pericardiocentesis. He recovered and remained in sinus rhythm.
Four years later, he experienced the onset of hemoptysis that was small in volume but frequent, associated
Discussion
Pulmonary vein stenosis occurs in approximately 3% to 15% of patients following radiofrequency ablation for atrial fibrillation, but symptomatic pulmonary venoocclusive disease is rare [9]. Presenting symptoms include hemoptysis, dyspnea, and cough. The underlying pathophysiology is postobstruction venous congestion in most cases. The timing of symptom onset following ablation is variable, occurring in some patients years after the intervention [10], whereas others report symptoms immediately
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