Open bronchial stump post-pneumonectomy: findings on xenon-133 ventilation imaging

A 67-yr-old male status post right pneumonectomy for non-small cell lung cancer who later developed an open right bronchial stump underwent a ventilation-perfusion lung scan because of episodes of recurrent dyspnea suspected to be due to pulmonary embolism. Xenon-133 ventilation images showed both rapid entry into and later washout of activity from the air-filled portion of the right thoracic cavity. A wide-open bronchial stump, documented both at bronchoscopy and later autopsy, allowed the xenon gas to freely wash out from the thoracic cavity, resulting in a different imaging pattern than for a typical bronchopleural fistula, which is usually characterized by prolonged trapping of radioactive gas within the pleural space.