PMC6409381_01
CTA at initial presentation (January 2017).
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Caucasian male with a past medical history significant for Crohn's disease and atrial fibrillation status post RFA in September 2016 initially presented in January 2017 with a history of recurrent hemoptysis, cough, exertional dyspnea, and fever while on vedolizumab and clopidogrel. Computed tomography angiography (CTA) showed multifocal left upper lobe (LUL) opacities and an ipsilateral pleural effusion with no evidence of pulmonary embolism, (Fig. 1).
V/Q scan ventilation.
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Ventilation/Quantitative perfusion scan (Fig. 2, Fig. 3) showed hypoperfusion of the left lung (overall 95% perfusion in right lung, 5% perfusion in left lung) and reduced perfusion in the LUL (12% LUL vs. 88% left lower lobe).
Left upper lobe lung biopsy.
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Video assisted thoracoscopic biopsy of the LUL revealed venous infarcts associated with edema and fibrosis of interlobular septa, (Fig. 4).
CT Coronary Angiography (February 2017). Red Arrow: Complete occlusion of left superior pulmonary vein. Yellow Arrow: Moderate stenosis of left inferior pulmonary vein.
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Dedicated CT coronary angiography revealed complete occlusion of the left superior pulmonary vein and stenosis of the left inferior pulmonary vein, (Fig. 5).
CTA status post PCI of left inferior pulmonary vein.
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Repeat CTA after the procedure noted almost complete resolution of the multifocal left upper lobe opacifications and resolution of the ipsilateral left sided pleural effusion, (Fig. 6).