title: Abolished ventilation and perfusion of lung caused by blood clot in the left main bronchus: auto-downregulation of pulmonary arterial blood supply.
abstract: It is generally assumed that the lungs possess arterial autoregulation associated with bronchial obstruction. A patient with pneumonia and congestive heart failure unexpectedly developed frequent haemoptysis. High-resolution CT and diagnostic CT were performed as well as ventilation/perfusion (V/Q) scintigraphy with single-photon emission CT (SPECT)/CT. V/Q SPECT/CT demonstrated abolished ventilation due to obstruction of the left main bronchus and markedly reduced perfusion of the entire left lung, a condition that was completely reversed after removal of a blood clot. We present the first pictorially documented case of hypoxia-induced pulmonary vasoconstriction and flow shift in a main pulmonary artery due to a complete intrinsic obstruction of the ipsilateral main bronchus. The condition is reversible, contingent on being relieved within a few days.
authors.affiliation: Department of Nuclear Medicine, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Denmark Section of Clinical Physiology and Nuclear Medicine, Department of Diagnostic Imaging, University Hospital of Copenhagen; North Zealand Hospital, Hillerød, Dyrehavevej 29, DK-3400, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Afzelius
authors.affiliation: Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Bergmann
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, 239, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Kettegård Allé 30,DK- 2650, Denmark.
authors.forename: J H
authors.initials: JH
authors.lastname: Henriksen
mesh_terms: D001999:Bronchoscopy; D003371:Cough / Q000209:etiology; D015536:Down-Regulation; D004417:Dyspnea / Q000209:etiology; D005334:Fever / Q000209:etiology; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008168:Lung / Q000473:pathology*; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011014:Pneumonia / Q000209:etiology; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014692:Ventilation-Perfusion Ratio
chemical_list: D005839:Gentamicins; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin