Triangle-like stenosis of pulmonary vein: A case report

Triangle-like stenosis of pulmonary vein: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Triangle-like stenosis of pulmonary vein: A case report Chan Zhou, Bo Li, Zhipeng Yang, Jing Li, xin Wang, Sheng Zhang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8749889/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Fibrosing mediastinitis is a rare chronic fibrotic disease of the mediastinum. Fibrous tissue proliferation compresses the pulmonary veins, causing stenosis, obstructing pulmonary circulation reflux, leading to pulmonary congestion and pulmonary hypertension, with symptoms such as dyspnea and hemoptysis. Diagnosis relies on contrast-enhanced chest CT and pulmonary angiography. Treatment is mainly based on drugs to inhibit fibrosis, interventional procedures or surgery to relieve obstruction. The prognosis is closely related to the lesion scope and intervention timing. Figures Figure 1 Full Text A 69-year-old female patient presented with exertional dyspnea for 2 years. Echocardiography showed enlarged right heart, mild tricuspid regurgitation, and elevated systolic pulmonary artery pressure. Contrast-enhanced chest CT indicated bilateral hilar soft tissue density shadow with calcified nodules, bilateral inferior pulmonary arteries (PAs) and superior pulmonary veins (PVs) stenosis. Accordingly, fibrous mediastinitis（FM）caused pulmonary vessel stenosis was diagnosed. After PAs stenting, we targeted superior PVs lesions. Selected PV angiography showed severe stenosis of the first drainage branch of left superior PV (Arrow in Figure A) and the second drainage branch of right superior PV. In order to further know the detailed information inside the stenotic PV, we performed intravenous ultrasound（IVUS）and optical coherence tomography（OCT）examination which showed triangle-like lumen with extra-vessel fibrous tissues, a little bit organized thrombus and no significant intima proliferation (Figure B and C). After stenting, selected PV angiography showed no visual stenosis (Arrow in Figure D); however, IVUS and OCT indicated slightly under-expanded stent (Figure E and F). No further post-dilation was performed as no gradient pressure across the stent by catheter. Rivaroxaban (20 mg/day) and aspirin (100 mg/day) were followed. Conclusively, endovascular imaging provides detailed information and new insight about FM-caused PV stenosis [1] ， with the goal of differential diagnosis and guiding interventional procedural. Abbreviations CT：Computerized tomography PAs:Pulmonary Arteries PVs:Pulmonary Veins FM:Fibrosing Mediastinitis IVUS:Intravascular Ultrasound OCT:Optical Coherence Tomography Declarations Acknowledgements: We thank the Department of Pathology and Imaging of the GANSU PROVINCIAL HOSPITAL for providing information. Funding: None. Author Contribution: Write the paper and literature search: CZ,BL; Provide writing ideas, guide articlewriting and finalize:XHL; Collect data and provide cases: ZPY,JL,XW,YCW,JZ. All authors readand approved the final manuscript Data Availability: The datasets used and/or analyzed during the current study available from thecorresponding author on reasonable request. Ethics approval and consent to participate: This study was approved by the Ethics Committee of the GANSU PROVINCIAL HOSPITAL. Consent for publication: Written informed consent was obtained from the patient for publication ofthis case report and any accompanying images. Clinical trial number: not applicable. Competing Interest: The authors declare that they have no competing interests. References Zablah JE, O'Callaghan B, Shorofsky M, Ivy D, Morgan GJ. Technical Feasibility on the Use of Optical Coherence Tomography in the Evaluation of Pediatric Pulmonary Venous Stenosis. Pediatr Cardiol 2022. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviewers invited by journal 12 Feb, 2026 Editor invited by journal 04 Feb, 2026 Editor assigned by journal 03 Feb, 2026 Submission checks completed at journal 03 Feb, 2026 First submitted to journal 31 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8749889","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":591923906,"identity":"9830501a-bf89-4afb-acb6-c515aaf66982","order_by":0,"name":"Chan Zhou","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Chan","middleName":"","lastName":"Zhou","suffix":""},{"id":591923908,"identity":"824024b4-7e07-4811-baf3-12d8bc86731d","order_by":1,"name":"Bo Li","email":"","orcid":"","institution":"Gansu Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Li","suffix":""},{"id":591923909,"identity":"4e3b5309-439a-44f3-9388-9b28de4c0558","order_by":2,"name":"Zhipeng Yang","email":"","orcid":"","institution":"Gansu University of Chinese Medicine First Clinical Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zhipeng","middleName":"","lastName":"Yang","suffix":""},{"id":591923912,"identity":"30688868-0823-498f-b18e-0d962d0d708e","order_by":3,"name":"Jing Li","email":"","orcid":"","institution":"Gansu University of Chinese Medicine First Clinical Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Li","suffix":""},{"id":591923914,"identity":"0551f4bd-d974-43c1-98cf-f538893a3c22","order_by":4,"name":"xin Wang","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"xin","middleName":"","lastName":"Wang","suffix":""},{"id":591923916,"identity":"d549da84-f3fe-443b-802e-8fb991cbaceb","order_by":5,"name":"Sheng Zhang","email":"","orcid":"","institution":"Gansu University of Chinese Medicine First Clinical Medical College","correspondingAuthor":false,"prefix":"","firstName":"Sheng","middleName":"","lastName":"Zhang","suffix":""},{"id":591923922,"identity":"d495ee01-ace1-4ef4-8493-fa98af037ace","order_by":6,"name":"Yichen Wang","email":"","orcid":"","institution":"Gansu University of Chinese Medicine First Clinical Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yichen","middleName":"","lastName":"Wang","suffix":""},{"id":591923929,"identity":"19b93752-df7c-4d77-b62c-e24d22b23a4c","order_by":7,"name":"Jing Zeng","email":"","orcid":"","institution":"Gansu Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zeng","suffix":""},{"id":591923935,"identity":"c5665339-fb62-4466-af18-77f38ae686a5","order_by":8,"name":"Xinghui Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYDACZjCSYGaTP3zgwIcfJGhh55NgSzw4s4d4ixj45SR4jA9zsBGh3OA47+HXhW0W0mzSPR8OM/AwyPOLHcCvRbKZL816ZpuEMZvM2Q2HCywYDGfOTsCvhZ+Zx8yYt00imY0hd8PhGTwMCQa3CWhhg2qpb2PIeXCYh40ILUBbjB8DtTCzSeQwEKdFspnHjJnnHFALzzEDYCBLEPaLwfkzxp95yuqY5dubH3/48MNGnl+agBaQdySQOBI4lSED5g9EKRsFo2AUjIKRCwDK9jnpH9/j8QAAAABJRU5ErkJggg==","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":true,"prefix":"","firstName":"Xinghui","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2026-01-31 12:39:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8749889/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8749889/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102892526,"identity":"0ef5822f-ddba-47b4-96c5-ee035e87afd1","added_by":"auto","created_at":"2026-02-18 05:25:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":376270,"visible":true,"origin":"","legend":"\u003cp\u003eFigure A、D. Pulmonary vein angiography.\u003c/p\u003e\n\u003cp\u003eFigure B、E. Pulmonary vein IVUS.\u003c/p\u003e\n\u003cp\u003eFigure C、F. Pulmonary vein OCT.\u003c/p\u003e\n\u003cp\u003eBefore (A、B、C) (Red arrows, stenosis sites) and after（D、E、F）（Red arrows，no visual stenosis）stenting.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8749889/v1/2404f9f79ed8d708ea73fe46.png"},{"id":102963967,"identity":"adbe8194-8917-4a22-94f4-49a248ddec72","added_by":"auto","created_at":"2026-02-19 04:21:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":672824,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8749889/v1/0ef33e13-5ea6-4ae2-82ab-c65073ef9103.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eTriangle-like stenosis of pulmonary vein: A case report\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"\u003cp\u003eA 69-year-old female patient presented with exertional dyspnea for 2 years. Echocardiography showed enlarged right heart, mild tricuspid regurgitation, and elevated systolic pulmonary artery pressure. Contrast-enhanced chest CT indicated bilateral hilar soft tissue density shadow with calcified nodules, bilateral inferior pulmonary arteries (PAs) and superior pulmonary veins (PVs) stenosis. Accordingly, fibrous mediastinitis（FM）caused pulmonary vessel stenosis was diagnosed. After PAs stenting, we targeted superior PVs lesions. Selected PV angiography showed severe stenosis of the first drainage branch of left superior PV (Arrow in\u0026nbsp;Figure\u0026nbsp;A) and the second drainage branch of right superior PV. In order to further know the detailed information inside the stenotic PV, we performed intravenous\u0026nbsp;ultrasound（IVUS）and optical coherence tomography（OCT）examination which showed triangle-like lumen with extra-vessel fibrous tissues, a little bit organized thrombus and no significant intima proliferation (Figure\u0026nbsp;B and C). After stenting, selected PV angiography showed no visual stenosis (Arrow in\u0026nbsp;Figure\u0026nbsp;D); however, IVUS and OCT indicated slightly under-expanded stent (Figure\u0026nbsp;E and F). No further post-dilation was performed as no gradient pressure across the stent by catheter. Rivaroxaban (20 mg/day) and aspirin (100 mg/day) were followed. Conclusively, endovascular imaging provides detailed information and new insight about FM-caused PV stenosis\u003csup\u003e[1]\u003c/sup\u003e， with the goal of differential diagnosis and guiding interventional procedural.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCT：Computerized tomography\u003c/p\u003e\n\u003cp\u003ePAs:Pulmonary Arteries\u003c/p\u003e\n\u003cp\u003ePVs:Pulmonary Veins\u003c/p\u003e\n\u003cp\u003eFM:Fibrosing Mediastinitis\u003c/p\u003e\n\u003cp\u003eIVUS:Intravascular Ultrasound\u003c/p\u003e\n\u003cp\u003eOCT:Optical Coherence Tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the Department of Pathology and Imaging of the GANSU PROVINCIAL HOSPITAL for providing information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWrite the paper and literature search: CZ,BL; Provide writing ideas, guide articlewriting and finalize:XHL; Collect data and provide cases: ZPY,JL,XW,YCW,JZ. All authors readand approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from thecorresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the GANSU PROVINCIAL HOSPITAL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication ofthis case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZablah JE, O\u0026apos;Callaghan B, Shorofsky M, Ivy D, Morgan GJ. Technical Feasibility on the Use of Optical Coherence Tomography in the Evaluation of Pediatric Pulmonary Venous Stenosis. Pediatr Cardiol 2022.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8749889/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8749889/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFibrosing mediastinitis is a rare chronic fibrotic disease of the mediastinum. Fibrous tissue proliferation compresses the pulmonary veins, causing stenosis, obstructing pulmonary circulation reflux, leading to pulmonary congestion and pulmonary hypertension, with symptoms such as dyspnea and hemoptysis. Diagnosis relies on contrast-enhanced chest CT and pulmonary angiography. Treatment is mainly based on drugs to inhibit fibrosis, interventional procedures or surgery to relieve obstruction. The prognosis is closely related to the lesion scope and intervention timing.\u003c/p\u003e","manuscriptTitle":"Triangle-like stenosis of pulmonary vein: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 05:25:35","doi":"10.21203/rs.3.rs-8749889/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T07:11:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T07:49:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316599389516057210382209915299707619581","date":"2026-02-12T06:57:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T06:00:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302057652997838131532408445407097328881","date":"2026-02-12T05:48:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T05:37:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-04T09:29:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-03T09:23:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T09:21:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-01-31T12:30:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31c8fbab-cdb1-484f-a07a-a2ec3c011e0c","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T02:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 05:25:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8749889","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8749889","identity":"rs-8749889","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}