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MUCOUS PLUG
Authored By: Shane Inoue and Henry Royal.
Patient: 31 year old male
History: 31-year-old man with Duchenne's muscular dystrophy, currently hospitalized with complaints of chest pain and shortness of breath.  He is status-post tracheostomy following a prior hospitalization for pneumonia and respiratory failure and uses a home ventillator at night.  He acutely desaturated to 70% during a bowel movement on the day of the examination and was also complaining of acute chest pain, severity 10/10.  On the day prior to this study, the patient underwent a bronchoscopy the day prior, which demonstrated increased secretions in the right lower lobe.
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Fig. 1
DTPA aerosol ventillation

Fig. 2
Tc-99m MAA perfusion

Fig. 3
CXR
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Findings: The comparison portable chest radiograph performed on 08/15/2007 demonstrates minimal bibasilar atelectasis. The technetium 99m DTPA aerosol images show deposition of the aerosol in the right lung, with no deposition in the left lung. The perfusion images show mildly heterogenous perfusion of both lungs, without any peripheral segmental perfusion abnormalities.
DDx: Mucous obstructing the bronchial lumen.
Intrinsic or extrinsic compressive lesions obstructing ventillation.
Diagnosis: Left-sided mucous plug.
General Discussion: The patient underwent bronchoscopy on August 16, this time showing left upper lobe, left middle lobe, and left lower lobe moderate secretions which were suctioned. The right side was visualized to the segmental level and no secretions were seen.
Specific Discussion: The perfusion of an underventillated lung leads to ventillation-perfusion mismatch that results in hypoxemia.  It is important to alert the referring clinician of this finding so that the appropriate interventions may be taken.
References: Mettler, FA, Guiberteau, MJ.  Essentials of Nuclear Medicine Imgaing, 5th ed.  Philadelphia, Saunders, 2006.
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Additional Details:

Case Number: 114143Owner(s): Shane Inoue and Henry RoyalLast Updated: 02-07-2013
Anatomy: Cardiopulmonary   Pathology: Other
Modality: Conventional Radiograph, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: mucous plug

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Certified by Henry Royal on 09-17-2009

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