Figure 10b. Pulmonary venous thrombosis and pulmonary infarction in a 48-year-old woman presenting with hemoptysis and pain in the left side of the chest. The patient had undergone successful RF ablation for recurring paroxysmal atrial fibrillation in the left superior pulmonary vein 4 months earlier. Fiber-optic bronchoscopy demonstrated hypervascular mucosa in the left upper lobe bronchus. A transesophageal echocardiogram was unremarkable. Chest radiographs (not shown) depicted alveolar areas of increased opacity in the left upper lobe. (a) Anterior perfusion lung scan shows hypoperfusion of the left lung. (The ventilation lung scan, which is not shown, was normal.) (b) Axial CT section shows increased attenuation, septal thickening (arrowhead), and rounded areas of consolidation (arrow) in the left upper lobe. (c) Axial contrast-enhanced CT scan shows stenosis and thrombosis in the left superior PV (arrow). (d) Coronal three-dimensional gradient-echo MR angiogram shows hypoperfusion of the left lung during the arterial phase. (e) Coronal venous phase three-dimensional gradient-echo MR angiogram shows hypoperfusion of the left lung, absence of venous flow in the left upper lobe, and thrombosis (arrow) of the left superior pulmonary vein. (f) Coronal maximum-intensity projection image obtained with a three-dimensional gradient-echo MR angiographic sequence shows hypoperfusion of the left lung and absence of venous flow in the left upper lobe.