Importance of a hybrid lung scintigraphy in patients with emphysema – case report

Overview

Introduction: COPD with emphysema is a serious disease which can cause pulmonary hypertension. Clinical symptomatology can mimic symptoms of pulmonary embolism (dyspnea, weakening, hemoptysis). Lung V/Q scintigraphy is an optimal procedure to exclude pulmonary embolism. However, air flow through bronchi is limited so distribution of lung ventilation can be challenged in COPD. Lung ventilation scintigraphy, therefore, can be insufficient for exclusion pulmonary embolism.

Case report: 80-y-old woman was sent to our department to exclude pulmonary embolism. She was a long-lasting smoker; she has a chronic cough during her lifelong being. Patient was examined at internal department for swelling of lower extremities with varicose ulcers. Ultrasonography did not confirm deep venous thrombosis, only dilatation of vena saphena magna with a reflux at the sapheno-femoral junction. CT pulmonary angiography did not confirm pulmonary embolism.

There were quite non-homogenous perfusion of both lungs with a large non-segmental perfusion defects on perfusion scintigraphy; ventilation was completely non-evaluable due to very poor inhalation of ^81mKr gas on lung ventilation scintigraphy, so we were not able to exclude pulmonary embolism with certainty. We detected serious parenchymal changes with a significantly reduced density with bulous character on a low dose nondiagnostic CT. So, we can exclude pulmonary embolism and confirm COPD with emphysema as a cause of clinical symptoms.

Conclusion: Hybrid lung scintigraphy in patients with COPD and emphysema is able to explain the cause of dyspnea and simultaneously exclude pulmonary embolism by confirmation of parenchymal changes.

Keywords:

lung scintigraphy – SPECT/CT – Emphysema – COPD