Case Author(s): J. Philip Moyers, M.D. and Henry D. Royal, M.D. , 12/5/95 . Rating: #D2, #Q3

Diagnosis: Idiopathic bronchial stenosis

Brief history:



Perfusion images from VQ scan

View main image(vq) in a separate image viewer

View second image(vq). Ventilation images from VQ scan

View third image(xr). Pa Chest Radiograph

View fourth image(ct). Axial section from Chest CT, mediastinal windows

Full history/Diagnosis is available below

Diagnosis: Idiopathic bronchial stenosis

Full history:

This patient has known right bronchus intermedius bronchial stenosis and a history of tracheal stenosis in 1988. Recent bronchoscopy demonstrated the stenosis in the bronchus intermedius and this stenosis was dilated at the time of the bronchoscopy.


11.3 mCi Xe-133 gas by inhalation and 3.6 mCi Tc-99m MAA i.v.


Poor washin of the Xe-133 is demonstrated on the washin images in the right middle and lower lobes. This corresponds well with the decreased perfusion demonstrated in these regions on the perfusion images. Delayed washout and prolonged retention of Xe-133 is demonstrated during the washout phase of the ventilation portion of the examination.


This patient carries a diagnosis of idiopathic bronchial stenosis. The patient is status post at least two dilatation attempts of the bronchus intermedius. CT examination (included) demonstrates narrowing of the bronchus intermedius without evidence for extraluminal mass. There is no evidence for mass involving the right-sided intralobar artery. This case demonstrates the physiologic hypoxic vasoconstriction that can occur in areas of lung that are not well ventilated. Decreased perfusion is demonstrated on the perfusion images and on chest radiograph (not included) relative oligemia is demonstrated in the right lower lung zone. Lung windows of the chest CT also demonstrate relative oligemia of the right lower lung zone compared to the left lower lung zone.

ACR Codes and Keywords:

References and General Discussion of Ventilation Perfusion Scintigraphy (Anatomic field:Lung, Mediastinum, and Pleura, Category:Organ specific)

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Case number: vq015

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