心房颤动患者射频消融术后肺静脉闭塞伴肺梗死的CT征象

CT Diagnosis of Pulmonary Vein Occlusion and Pulmonary Infarction after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

【目的】分析经导管射频消融术后并发肺静脉闭塞所致肺梗死患者的CT征象,提高临床医师和影像学医师对该并发症的认识。【方法】回顾分析行经导管射频消融术后并发肺静脉闭塞导致肺梗死的2例心房颤动患者的胸部CT表现,并对其诊断机制进行探讨。【结果】2例患者均因心房颤动曾行射频消融术治疗。例1术后1周起出现非特异性呼吸系统临床症状,术后第6周胸部CT检查显示肺内多个片状实变影散在分布于肺内,边界模糊,实变影周边见小叶间静脉增粗,符合静脉性肺梗死急性出血期改变。例2术后3年出现非特异性呼吸系统临床症状,多次胸部CT检查显示左上肺叶内多个结节状、片状密影呈此消彼长改变,伴小叶间隔增厚,左肺上叶脏层胸膜明显增厚,符合静脉性肺梗死慢性期改变,并经手术病理证实。【结论】经导管射频消融术后并发肺静脉闭塞导致的急性和慢性静脉性肺梗死的胸部CT征象不同,熟悉其基本表现和相关病理基础有助于提高对该并发症的认识。

【Objective】To improve the knowledge of pulmonary vein occlusion and pulmonary infarction as complications of radiofrequency catheter ablation through analysis of CT demonstrations of these patients.【Methods】Thoracic CT demonstrations of two patients with pulmonary infarction due to pulmonary vein occlusion after radiofrequency catheter ablation for atrial fibrillation were retrospectively analyzed.【Results】Both of the two patients underwent radiofrequency catheter ablation for atrial fibrillation.Case 1 had non-specific clinical symptoms of respiratory system one week after the operation.Thoracic CT scans at the sixth post-operative week demonstrated bilaterally distributed multiple patchy consolidated lesions with blurred margins and dilation of surrounding interlobular veins,which were consistent with the changes in acute venous pulmonary infarction.Case 2 began to present non-specific clinical symptoms of respiratory system three years after the operation.A series of thoracic CT scans demonstrated recurrent nodular and patchy lesions in the upper left lobe,with thickness of the interlobular septa and the visceral pleura of the left upper lobe,which were consistent with the changes in chronic venous pulmonary infarction,and was confirmed by surgical pathology.【Conclusions】Acute and chronic venous pulmonary infarction due to pulmonary vein occlusion as complications of radiofrequency catheter ablation have different thoracic CT demonstrations.Acquaintance of their features and underlying pathological process is helpful for improving the understanding of these complications.