Pattern of a vanishing lung syndrome on a hybrid lung perfusion scintigraphy – case report

Overview

Introduction: Chronic obstructive pulmonary disease(COPD) with emphysema is a serious condition which can cause pulmonary hypertension. Clinical symptoms can mimic pulmonary embolism (dyspnea, collapse, hemoptysis). Lung perfusion scintigraphy is an optimal procedure to exclude pulmonary embolism. Interpretation can be, however, difficult in a serious bullous emphysema.

Case report: 50-y-old patient was sent to our department to assess lung perfusion due to suspicious pulmonary hypertension on August 2024. Echocardiography was difficult to perform. He was diagnosed with a pulmonary embolism as an incidental finding on April 2024. He had a various pulmonary history with repetitive bronchopneumonias including non-tuberculous mykobacterioses with a mycetoma in the left upper lobe. He was followed due to COPD of the 4th stage, grade D up to vanishing lung syndrome. Oxygen blood saturation was 99 %, there were no significant abnormalities of his blood count or biochemical analysis. He was treated

with anticoagulants; he was clinically stable all the time.

Lung perfusion scintigraphy revealed no perfusion of all the right lung, distribution of left lung perfusion was non-homogeneous, without segmental defects, with the absence of perfusion of the ventral areas but without relation to lung segmental anatomy. Non-diagnostic CT revealed almost total absence of lung parenchyma in the right lung and ventral parts of the left lung, giant cavities filled with air, and mediastinal shift to the right. Air-filled cavities corresponded to perfusion defects on scintigraphy, we, therefore, can exclude lung embolism as well as chronic thromboembolic pulmonary hypertension (CTEPH).

Conclusion: Hybrid lung perfusion scintigraphy in patients with a vanishing lung syndrome can demonstrate a relation of perfusion to the present lung parenchyma, thus it can exclude pulmonary embolism including CTEPH.

Keywords:

Pulmonary embolism – vanishing lung syndrome – hybrid scintigraphy