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Open Bronchial Stump Post-Pneumonectomy: Findings on Xenon-133 Ventilation Imaging

Nuclear Medicine Section, Department of Veterans Affairs Medical Center, Seattle, Washington

Correspondence: For correspondence or reprints contact: Arnold F. Jacobson, MD, PhD, Nuclear Medicine Section, Dept. of Veterans Affairs Medical Center, 1660 S. Columbian Way (115), Seattle, WA 98108.

ABSTRACT

A 67-yr-old male status post right pneumonectomy for non-small cell lung cancer who later developed an open right bronchial stump underwent a ventilation-perfusion lung scan because of episodes of recurrent dyspnea suspected to be due to pulmonary embolism. Xenon-133 ventilation images showed both rapid entry into and later washout of activity from the air-filled portion of the right thoracic cavity. A wide open bronchial stump, documented both at bronchoscopy and later autopsy, allowed the xenon gas to freely wash out from the thoracic cavity, resulting in a different imaging pattern than for a typical bronchopleural fistula, which is usually characterized by prolonged trapping of radioactive gas within the pleural space.

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