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Background <p>Hemoptysis in adults is rarely caused by congenital vascular anomalies, leading to frequent diagnostic oversight. Unilateral pulmonary vein atresia is a rare congenital anomaly in adults that may mimic chronic thromboembolic pulmonary disease (CTEPD) on single-phase computed tomography pulmonary angiography (CTPA). This radiologic mimicry frequently leads to misdiagnosis and inappropriate anticoagulation. We report a case illustrating this diagnostic pitfall and the critical role of dual-phase imaging.</p> Case presentation <p>A 58-year-old woman presented with worsening hemoptysis. Despite a 50-year history of intermittent bleeding, she had recently been diagnosed with CTEPD based on flow artifacts mimicking filling defects seen on single-phase CTPA and started on oral anticoagulants, which exacerbated her symptoms. The discordance between the extensive radiological occlusion and her stable cardiopulmonary status prompted re-evaluation. Dual-phase CTPA demonstrated delayed arterial opacification and absent pulmonary veins, confirming congenital unilateral pulmonary vein atresia. The initial “thrombus” was identified as a flow artifact caused by hemodynamic stasis. Anticoagulation was immediately ceased. The patient underwent successful superselective embolization of hypertrophied systemic collaterals. She remained asymptomatic at follow-up.</p> Conclusions <p>Congenital unilateral pulmonary vein atresia can simulate pulmonary embolism on pulmonary arterial-phase imaging, creating a pseudo-obstruction. Clinicians should suspect this anomaly in adults with long-standing hemoptysis when imaging findings of extensive thrombosis do not align with clinical presentation. Dual-phase CTPA is the critical problem-solving tool to differentiate true pulmonary artery thromboembolism from flow artifacts, thereby preventing dangerous anticoagulation and guiding appropriate management.</p>

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Pseudo-obstruction on single-phase CTPA: unilateral pulmonary vein atresia as the cause of 50 years of hemoptysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Anqi Liu,
  • Linfeng Xi,
  • Min Liu

摘要

Background

Hemoptysis in adults is rarely caused by congenital vascular anomalies, leading to frequent diagnostic oversight. Unilateral pulmonary vein atresia is a rare congenital anomaly in adults that may mimic chronic thromboembolic pulmonary disease (CTEPD) on single-phase computed tomography pulmonary angiography (CTPA). This radiologic mimicry frequently leads to misdiagnosis and inappropriate anticoagulation. We report a case illustrating this diagnostic pitfall and the critical role of dual-phase imaging.

Case presentation

A 58-year-old woman presented with worsening hemoptysis. Despite a 50-year history of intermittent bleeding, she had recently been diagnosed with CTEPD based on flow artifacts mimicking filling defects seen on single-phase CTPA and started on oral anticoagulants, which exacerbated her symptoms. The discordance between the extensive radiological occlusion and her stable cardiopulmonary status prompted re-evaluation. Dual-phase CTPA demonstrated delayed arterial opacification and absent pulmonary veins, confirming congenital unilateral pulmonary vein atresia. The initial “thrombus” was identified as a flow artifact caused by hemodynamic stasis. Anticoagulation was immediately ceased. The patient underwent successful superselective embolization of hypertrophied systemic collaterals. She remained asymptomatic at follow-up.

Conclusions

Congenital unilateral pulmonary vein atresia can simulate pulmonary embolism on pulmonary arterial-phase imaging, creating a pseudo-obstruction. Clinicians should suspect this anomaly in adults with long-standing hemoptysis when imaging findings of extensive thrombosis do not align with clinical presentation. Dual-phase CTPA is the critical problem-solving tool to differentiate true pulmonary artery thromboembolism from flow artifacts, thereby preventing dangerous anticoagulation and guiding appropriate management.