Multidisciplinary Management of Hemoptysis due to Pulmonary Vein Stenosis (JACC Case Reports April 2025)-Article: Multidisciplinary Management of Hemoptysis due to Pulmonary Vein Stenosis

Article: Multidisciplinary Management of Hemoptysis due to Pulmonary Vein Stenosis

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The document presents a case study on the multidisciplinary management of a 41-year-old male patient who developed hemoptysis and ground-glass opacities (GGOs) following an atrial fibrillation ablation procedure due to pulmonary vein stenosis (PVS). Initially, the patient experienced no symptoms besides the hemoptysis after undergoing radiofrequency ablation for atrial fibrillation. Ground-glass opacities were detected in the left upper lobe during chest CT scans; differential diagnoses considered included vasculitis, infection, and interstitial lung disease, but these were ruled out through extensive testing. The final diagnosis of high-grade stenosis in the left upper pulmonary vein was confirmed via a pulmonary vein protocol CT scan.<br /><br />Conservative management was opted for due to the patient’s asymptomatic nature post-hemoptysis and the risks associated with invasive interventions like stenting, which have high restenosis rates. This case underscores the importance of considering PVS in patients who exhibit hemoptysis and GGOs following atrial fibrillation ablation. It highlights the role of a multidisciplinary approach, involving pulmonology, cardiology, and radiology teams, in diagnosing and managing this condition. The document emphasizes that conservative management might be a feasible alternative in asymptomatic cases, provided there is close follow-up.<br /><br />The publication highlights the rarity and complexity of diagnosing PVS post-ablation, encouraging clinicians to prioritize thorough differential diagnoses to exclude other significant pathologies such as vasculitis, infection, and interstitial lung disease. The content emphasizes ongoing surveillance for potential symptom recurrence or stenosis progression in conservatively managed cases, underscoring the collaborative healthcare approach for optimal patient outcomes. The article concludes that PVS should be an essential consideration for patients displaying specific post-ablation symptoms, advocating for non-invasive management strategies where applicable.

Keywords

pulmonary vein stenosis

hemoptysis

ground-glass opacities

atrial fibrillation ablation

multidisciplinary management

conservative management

differential diagnosis

high-grade stenosis

non-invasive strategies

collaborative healthcare