The value of a preoperative ventilation-perfusion scan in patient selection for pneumonectomy

Guidelines regarding operability of patients with lung cancer are well established. The measured and predicted pulmonary function provides a practical guide to the safety of lobectomy or pneumonectomy. We describe a patient who had an unexplained precipitous fall in preoperative FEV(1) that would have precluded a required pneumonectomy but for an urgent ventilation-perfusion (V/Q) scan. This case highlights the fact that clinical acumen rather than a strict adherence to established guidelines is vital in the assessment of lung cancer patients awaiting potentially curative surgery.