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LUNG CANCER ON VQ SCAN
Authored By: Farrokh Dehdashti and O'Neil Lee.
Patient: 57 year old female
History: 57 year old woman with shortness of breath.
Image Size:[small][as-submitted]

Fig. 1
Tc-99m DTPA aeraol ventilation scan

Fig. 2
Perfusion scan

Fig. 3
AP portable CXR

Fig. 4
PE protocol chest CT
Image Size:[small][as-submitted]

Findings: Ventilation/Perfusion scan: Matching ventilation and perfusion defects in the superior segment of the right lower lobe. The perfusion defect appears larger than the ventilatory abnormality.
Chest Radiograph: Cardiomegaly, pulmonary edema, and right infrahilar mass.

Opinion: Intermediate likelihood ratio for pulmonary embolism.


CT: Right infrahilar mass, encasing pulmonary artery
DDx: 1. Centrally obstructing mass.

2. Pulmonary embolism.

3. Obstructive airway disease.


Diagnosis: Poorly differentiated non small cell lung cancer (biopsy proven)
General Discussion: Matched ventilatory and perfusion defect in which the perfusion abnormality is larger than the ventilatory abnormality is typically interpreted as "high likelihood ratio' for pulmonary embolism. In this case, a centrally obstructing mass (lung cancer) was causing partial obstruction of the pulmonary artery and bronchus. In general, vessels are more compliant than the airway (containing cartilage). As a result, a centrally obstructing mass often causes more significant narrowing of the vessel compared to the corresponding bronchus as seen in this case. It was felt that the perfusion defect matches in size the changes on the chest radiograph and thus was interpreted as "intermediate likelihood ratio' for pulmonary embolism.
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Additional Details:

Case Number: 105232Owner(s): Farrokh Dehdashti and O'Neil LeeLast Updated: 02-07-2013
Anatomy: Cardiopulmonary   Pathology: Neoplasm
Modality: CT, Conventional Radiograph, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: lung cancer

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Certified by Farrokh Dehdashti on 05-02-2008

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