Pulmonary vein stenosis refers to a spectrum of conditions characterized by narrowing of the pulmonary veins. It can be congenital or acquired.
primary pulmonary vein stenosis - occurs in children
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secondary pulmonary vein stenosis - occurs in adults and usually associated with some identifiable underlying causative process
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involvement of the pulmonary veins by an extrinsic process
neoplasm growth
iatrogenic procedures - radiofrequency ablation for atrial fibrillation (PVI ablation), incidence 1-3% 3.
post-surgical e.g. post-repair of anomalous pulmonary venous return
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Radiographic assessment
CT
ECG-gated contrast CT provides good spatial resolution. The pulmonary vein ostial diameters are usually measured. Some authors suggest normal pulmonary veins have an average diameter of 10 to 15 mm with a narrowing to approximately 4 to 6 mm is usually considered necessary to cause symptoms 4.
Indirect cross-sectional imaging findings in patients with PVS include:
lung opacities that wax and wane
areas of lung fibrosis
decreased lung perfusion
longer blood/contrast transit time in the lung that is drained by the stenosed pulmonary vein
Complications
Recognized complications include
pulmonary hypertension - pulmonary hypertensive crisis
recurrent intercurrent pulmonary infection
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