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Related Experiment Videos

Ventilation/perfusion mismatch caused by positive pressure ventilatory support.

C K Kim1, S Heyman

  • 1Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|July 1, 1989
PubMed
Summary

Interpreting lung scans in patients on positive pressure ventilation requires care. Findings can mimic pulmonary embolism due to ventilation-perfusion mismatches, complicating diagnosis.

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Area of Science:

  • Pulmonary Medicine
  • Radiology
  • Critical Care

Background:

  • Positive pressure ventilation is common in critically ill patients.
  • Accurate diagnosis of pulmonary embolism (PE) is crucial for patient management.
  • Ventilation-perfusion (V/Q) lung scans are used to evaluate for PE.

Observation:

  • A case of lobar atelectasis in a patient on positive pressure ventilation was studied.
  • V/Q imaging revealed absent ventilation and normal perfusion (reverse mismatch) in the atelectatic region.
  • Another lung zone showed normal ventilation and decreased perfusion (true mismatch), not attributable to PE.

Findings:

  • The observed V/Q scan patterns can be misleading in mechanically ventilated patients.
  • Reverse mismatch in atelectasis and true mismatch in other zones can mimic PE findings.

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  • These findings highlight the challenges in diagnosing PE in this patient population.

    • Implications:

    • Careful interpretation of V/Q lung scans is essential in patients receiving positive pressure ventilatory support.
    • Clinicians must consider the impact of ventilation strategies on V/Q scan interpretation.
    • This case underscores the need for a nuanced approach to PE diagnosis in ventilated patients.