Catheter ablation has become an established therapeutic option for atrial fibrillation, with continuously improving efficacy and safety profiles. Advances in mapping systems, energy delivery, and ablation strategies have contributed to a reduction in procedure-related complications. Nevertheless, pulmonary vein stenosis remains a recognised adverse outcome, particularly associated with thermal injury at or near the pulmonary vein ostia. Although its incidence has decreased with the widespread adoption of wide antral and circumferential ablation techniques, clinically relevant cases continue to be encountered in routine practice.

Pulmonary vein stenosis may lead to significant morbidity when diagnosis is delayed, largely owing to its variable clinical presentation and the nonspecific nature of associated imaging findings. Symptoms may be mild or absent, and pulmonary parenchymal changes are frequently misattributed to more common conditions, including infection, pulmonary embolism, or malignancy. In this context, imaging plays a central role in early recognition and accurate diagnosis.

The aim of this case series is to describe the imaging findings and clinical context of pulmonary vein stenosis following atrial fibrillation ablation, with particular emphasis on cross-sectional imaging features that may aid in its identification. By presenting four illustrative cases, this work seeks to highlight both direct and indirect radiological signs of pulmonary vein stenosis and to underline common diagnostic pitfalls.