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Lung Scintigraphy in Postpneumonectomy Dyspnea Due to a Right-to-Left Shunt

Service de Médecine Nucléaire, Hôpital d'Instruction des Armées du Val de Grâce, Paris, and CIERM, Service de Médecine Nucléaire, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France

Correspondence: For correspondence or reprints contact: Emmanuel Durand, CIERM- Hôpitalde Bicêtre, 78, rue du Gênêral Leclerc, F 94275 La Kremlin-Bicêtre CÉDEX, France.

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.

Key Words: ventilation • perfusion lung scan • pneumonectomy • dyspnea • platypnea-orthodeoxia

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