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Pulmonary vein stenosis is a known complication, usually underdiagnosed, of pulmonary vein isolation for the treatment of recurrent and drug-resistant atrial fibrillation. The current study describes a patient with acquired pulmonary vein stenosis after the catheter ablation of atrial fibrillation 4 years earlier. Pulmonary vein stenosis secondary to ablation of atrial fibrillation is associated with respiratory symptoms that frequently mimic more common diseases, often leading to erroneous diagnostic and therapeutic procedures. Awareness of this syndrome is important for proper and prompt management. (Clin Pulm Med 2010;17: 251-253) V arious types of ablation strategies have been used to achieve a high efficacy for all types of atrial fibrillation. However, these extensive and complex ablation strategies are associated with a relatively high incidence of complications.Pulmonary vein stenosis (PVS) is a potential complication and may lead to symptoms that are often underrecognized. The incidence of this complication has been reported to range from 3% to 42%, depending on the technique employed and the method of assessing pulmonary venous stenosis. 1-4 However, recently, the reported incidence of pulmonary venous stenosis resulting from radiofrequency ablation has decreased to Ͻ1% after a change in the site of ablation 5 from within the pulmonary veins, a reduction in the target temperature and quantity of radiofrequency energy delivery during the ablation procedure, 6 and maturing of the "learning curve" with increased operator experience. CASE REPORTA 42-year-old man presented a history of fever, chest pain, cough, hemoptysis, and mucus expectoration. His medical history was notable for left leg venous thrombosis and persistent atrial fibrillation that had been treated with several pulmonary venous isolation 4 years before. Physical examination and a routine blood test were unremarkable. A chest radiograph showed opacity in the left lower lobe. He was treated empirically for a communityacquired pneumonia. One-month later, he returned to the hospital with a new cough, dyspnea, and fever. Elevated D-dimer levels were noted, but a repeat chest radiograph showed some improvement in the previously noted left lower lobe opacity.Despite a low clinical probability for pulmonary embolism, a ventilation-perfusion scan (Fig. 1) was performed, which showed right upper lung areas of decreased perfusion without corresponding ventilatory abnormalities, consistent with a high probability for acute pulmonary embolism.Computed tomography (CT) pulmonary angiography showed no evidence of pulmonary embolism. This examination also showed abnormal soft tissue opacity surrounding the left lower lobe bronchus in close proximity to the left inferior pulmonary vein ( Fig. 2A), which suggested the first possible signs of lung cancer.A fiberoptic bronchoscopy showed inflammation within the distal left mainstem bronchus, but bronchoalveolar lavage and transbronchial biopsy showed no evidence of infection, including tuberculosis, or malign...

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