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Reverse Ventilation-Perfusion Mismatch in Lung Cancer Suggests Intrapulmonary Functional Shunting

Departments of Nuclear Medicine, Thoracic Surgery and Respiratory Physiology, Marie Lannelongue Surgical Center, Le Plessis-Robinson, France

Correspondence: For correspondence or reprints contact: Myriam Wartski, MD, Department of Nuclear Medicine, Marie Lannelongue Surgical Center, 133 Avenue de la Resistance, 92 350 Le Plessis-Robinson, France.

ABSTRACT

We report on a patient with squamous cell cancer of the left lung who was first considered ineligible for surgery because of severe hypoxemia. A ventilation-perfusion scan showed "reverse" ventilation-perfusion mismatch, with 20% of the total lung perfusion going to the left lung, which showed no ventilation with radioactive aerosols. This pattern suggested that the hypoxemia was due to intrapulmonary functional shunting and could therefore be improved by surgical resection of the tumor. Balloon occlusion of the left pulmonary artery resulted in an immediate rise in PaO₂, indicating a right-to-left intrapulmonary shunt. After left pneumonectomy, PaO₂ levels were normal. This patient provides an example of dysregulation of the pulmonary hypoxic vasoconstriction response in a non-small cell lung cancer. Lung cancer patients with severe hypoxemia should undergo ventilation-perfusion scanning to look for reverse ventilation-perfusion mismatch suggestive of intrapulmonary functional shunting.

Key Words: bronchial cancer • hypoxemia • intrapulmonary functional shunting • ventilation–perfusion lung scan

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