Bronchial obstruction (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

V/Q scan and NCCT

Nuclear medicine

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 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. 

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