Presentation
History of fibrosing mediastinitis with worsening shortness of breath.
Patient Data
Small volume right lung with increased opacity and mediastinal shift to the right.
Ventilation-perfusion scan:
near complete absence of perfusion in the right lung with only a small amount of radiotracer visible in the right lung base on posterior and RAO views
ventilation images show mildly decreased volume and ventilation of the right lung without focal abnormality
Enlarged calcified lymph nodes in the right hilum and subcarinal region.
Stenosis and dissection of the right pulmonary artery with poor filling of the distal right pulmonary arterial tree.
There is occlusion of the previously stented right inferior pulmonary vein. Occluded right superior pulmonary vein.
The right heart and main pulmonary artery are dilated, indicating pulmonary hypertension.
Case Discussion
Ventilation/perfusion scintigraphy (V/Q scan) is most frequently performed to evaluate for possible acute pulmonary embolism (PE), but many diseases can affect lung perfusion and may result in an abnormal exam. In this case, perfusion of the right lung is severely decreased and ventilation is only mildly reduced. The cause is apparent on the CT scan: fibrosing mediastinitis with stenosis and dissection of the right pulmonary artery as well as right pulmonary venous occlusion.
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