Pulmonary vein stenosis remains a clinically relevant complication of catheter ablation for atrial fibrillation, despite substantial reductions in incidence achieved through contemporary ablation techniques. Its diagnosis is often challenging due to delayed onset, variable symptomatology, and imaging findings that may mimic more common pulmonary conditions.

This case series illustrates the spectrum of direct and indirect imaging features associated with pulmonary vein stenosis and underscores the central role of contrast-enhanced computed tomography in its detection and characterisation. Multiplanar, maximum intensity projection, and three-dimensional reconstructions are particularly valuable in assessing venous patency and delineating the extent of disease.

Radiologists should maintain a high index of suspicion for pulmonary vein stenosis in patients with a history of atrial fibrillation ablation who present with unexplained or recurrent pulmonary opacities, regional perfusion abnormalities, or atypical clinical courses. Early recognition through appropriate imaging assessment may facilitate timely management and help to reduce long-term pulmonary morbidity.