Ventilation/perfusion scintigraphy revealed preserved ventilation while no pulmonary arterial perfusion of the right lung (arrowheads) was observed. Ventilation 'hot spots' (asterisk), congruent with massive bronchiectasis were also detected and matched CT-findings. 

Contexts in source publication

Context 1

... 1, a 36 year-old mother-of-three was admitted to the emergency department of our tertiary care medical center with haemoptysis after episodes of recurrent pulmonary infections. Case history revealed a similar episode about 7 years ago during pregnancy, treated in a primary hospital. Due to pregnancy, no in-depth diagnostic workup was performed and she was lost to post-partum follow-up. The recent diagnostic workup included an initial chest X-ray depicting diffuse patchy right-sided infiltrations, normal left lung and heart, but an amputated right hilum (Figure 1). Cardiac auscultation as well as electrocardiogram (ECG) was normal. Bronchoscopy revealed diffuse right bronchial bleeding, most pronounced in segments 2 and 3. Initial therapy included epinephrine-lavage of both upper and lower right lobes. During intervention the patient was intubated because of an oxygen desaturation due to massive pulmonary bleeding. After cardiorespiratory stabilization on the intensive care unit a computed tomography (CT) of the pulmonary arteries was performed revealing right-sided, isolated UAPA with multiple systemic feeder arteries ( Figure 2). Alveolar infiltrates concordant with parenchymal bleeding, bronchiectasis, and fibrosis were seen as well. As seen in Figure 3, subsequent aortic angiograms by DSA confirmed multiple systemic feeder arteries without proof of bleeding source. After 3 days she was extubated, the primary antibiotic regime was de-escalated and she was transferred to a normal ward. Further diagnostic workup included a 6-minutes-walking test showing a slight blood pressure increase, so a low dose beta blocker therapy has been started. Right heart catheter measurements were unsuspicious with no intracavitary and pulmonary artery pressures elevation. Transthoracic echocardiography (TTE) was normal. In preparation of a potential surgical approach, a lung ventilation/perfusion scan was performed yielding absence of right pulmonary perfusion, but only slightly decreased ventilation ( Figure 4). After 10 days on normal ward, her general conditions improved, antibiotic therapy has been stopped and no further episodes of haemoptysis appeared so that she was discharged and follow-up in an outpatient clinic. However, two weeks later, recurrent mild haemoptysis following hard physical labour led to re-admission. Reassessment and preparations for pneumonectomy were discussed, but further medical treatment was refused by the patient. Patient 2, a 63 year-old male with permanent atrial fibrillation, fusiform holosystolic murmur across the aortic valve and ECG changes (inverted T wave in II, aVL and V6) was transferred from domesticity to our hospital due to angina pectoris complaints. Known previous illnesses included episodes of pulmonary infections, type-2-diabetes and chronic renal failure stage II. Initial coronary angiography excluded coronary artery disease but confirmed an aortic valve stenosis III° and an ascending aortic aneurysm. Preoperative CT revealed a right-sided, isolated UAPA with systemic feeder arteries from the descending aorta and the inferior phrenic artery ( Figure 5). The right lung volume was reduced, probably due to a lesser extent of perfusion, and lung parenchyma displayed scarred-fibrotic alterations as a hint for past Ventilation 'hot spots' (asterisk), congruent with massive bronchiectasis were also detected and matched CT-findings. Between Simple Cough and Intensive Care. J Pulm Respir Med 8: 457. doi: 10.4172/2161-105X.1000457 ...

Context 2

... echocardiography (TTE) was normal. In preparation of a potential surgical approach, a lung ventilation/perfusion scan was performed yielding absence of right pulmonary perfusion, but only slightly decreased ventilation ( Figure 4). After 10 days on normal ward, her general conditions improved, antibiotic therapy has been stopped and no further episodes of haemoptysis appeared so that she was discharged and follow-up in an outpatient clinic. ...