Bronchial obstruction (V/Q scan)
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Dyspnea, cough, and hemoptysis. Background of metastatic renal cell carcinoma.
V/Q scan and NCCT
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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.
Renal impairment precluded CT pulmonary angiogram in this patient. After imaging, the patient was referred for a 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.