Case Author(s): Tate Allen, M.D. and Henry D. Royal, M.D. , 7/28/98 . Rating: #D3, #Q4

Diagnosis: Patent Ductus Arteriosus with Secondary Eisenmenger's Syndrome

Brief history:

This 48-year-old male with pulmonary hypertension is being evaluated for a lung transplant.

Images:

Perfusion Images

View main image(vq) in a separate image viewer

View second image(vq). Ventilation Images

Full history/Diagnosis is available below

Diagnosis: Patent Ductus Arteriosus with Secondary Eisenmenger's Syndrome

Full history:

The patient has hypoxemia and dyspnea on exertion. He has long standing pulmonary hypertension secondary to a large patent ductus arteriosus. Because of his hypoxemia, the patient's hematocrit is increased. He is treated with periodic phlebotomy.

Radiopharmaceutical:

13.1 mCi Xe-133 gas by inhalation and 4.2 mCi Tc-99m MAA i.v.

Findings:

The Xe-133 ventilation exam is normal. The perfusion images show no pulmonary defects. However, there is abnormal activity in the kidneys, spleen and bone marrow. These findings are consistent with a anatomic right to left shunt. The amount of activity in the bone marrow is unusual but is presumably related to a hyperactive bone marrow due to the patient's periodic phlebotomies.

Discussion:

The increased red cell turn-over due to the patient's periodic phlebotomies has caused bone marrow hyperplasia. The increased blood flow to the hyperplastic bone marrow is demonstrated by the increased MAA activity.

ACR Codes and Keywords:

References and General Discussion of Ventilation Perfusion Scintigraphy (Anatomic field:Heart and Great Vessels, Category:Normal, Technique, Congenital Anomaly)

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Case number: vq032

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