title: Lung scintigraphy in postpneumonectomy dyspnea due to a right-to-left shunt.
abstract: We report the case of a 50-yr-old man who experienced exertional dyspnea 5 mo after a left pneumonectomy for carcinoma. As the clinical features pointed toward a pulmonary embolism, we performed a ventilation plus perfusion radionuclide lung scan. It showed no evidence of pulmonary embolism, but it did show a systemic uptake of the isotope, suggesting a right-to-left shunt that was confirmed by contrast echocardiography, which revealed an atrial septal defect. Right-to-left shunts after pneumonectomy have already been reported and can be diagnosed by lung scintigraphy. Usually, a patent foramen ovale is encountered, but the underlying physiopathology remains under discussion. Clinically, right-to-left shunts are often related to platypnea-orthodeoxia.
authors.affiliation: Service de Médecine Nucléaire, Hôpital d'Instruction des Armées du Val de Grâce, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Durand
authors.forename: E
authors.initials: E
authors.lastname: Bussy
authors.forename: J F
authors.initials: JF
authors.lastname: Gaillard
mesh_terms: D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D013668:Technetium Tc 99m Aggregated Albumin; D014463:Ultrasonography; D014692:Ventilation-Perfusion Ratio
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin