Bronchial obstruction on V/Q scan

Case contributed by Dr James Harvey

Presentation

Dyspnea, cough, and hemoptysis. Background of metastatic renal cell carcinoma.

Patient Data

Age: 65 years
Gender: Male
Nuclear medicine

V/Q scan and NCCT

  • There is matched absent ventilation and perfusion to the right middle lobe and right lower lobes of the lung.
  • An unmatched perfusion defect is present in the lingula.
  • A pulmonary nodule (metastasis) is seen in the middle lobe.
  • The low-dose CT demonstrates an obstructing ovoid soft-tissue density lesion within the right main bronchus.

Case Discussion

Renal impairment precluded CT pulmonary angiogram in this patient. After imaging, the patient was referred for bronchoscopy. Biopsy of the lesion returned metastatic clear cell RCC. 

Airway obstruction is a cause of matched perfusion defect.
An endobrochial lesion or hilar mass can cause a ventilation defect by obstructing the bronchus. A compensatory decrease in perfusion may be seen (as in this case), resulting in a matched perfusion defect on V/Q scan.

The unmatched perfusion defect within the lingula was in keeping with a pulmonary embolus. 

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Case information

rID: 73738
Published: 21st Jan 2020
Last edited: 23rd Jan 2020
System: Oncology, Chest
Inclusion in quiz mode: Included