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FIGURE 4. Patient with severe case of chronic obstructive pulmonary disease (COPD) and pulmonary emphysema. Large emphysematic bullae in right upper lobe (E) led to false-positive diagnosis in V/Q scintigraphy (B and D, mismatch defects marked by arrows). No pulmonary embolism was diagnosed in course of consensus meeting. CT was true-negative. Inhomogeneous distribution of ventilation agent is typical for patients with COPD (A and C). V = ventilation scan; Q = perfusion scan; R = right; A = anterior; L = left.
