Abolished ventilation and perfusion of lung caused by blood clot in the left main bronchus: auto-downregulation of pulmonary arterial blood supply

BMJ Case Rep. 2015 Sep 15:2015:bcr2015209289. doi: 10.1136/bcr-2015-209289.

Abstract

It is generally assumed that the lungs possess arterial autoregulation associated with bronchial obstruction. A patient with pneumonia and congestive heart failure unexpectedly developed frequent haemoptysis. High-resolution CT and diagnostic CT were performed as well as ventilation/perfusion (V/Q) scintigraphy with single-photon emission CT (SPECT)/CT. V/Q SPECT/CT demonstrated abolished ventilation due to obstruction of the left main bronchus and markedly reduced perfusion of the entire left lung, a condition that was completely reversed after removal of a blood clot. We present the first pictorially documented case of hypoxia-induced pulmonary vasoconstriction and flow shift in a main pulmonary artery due to a complete intrinsic obstruction of the ipsilateral main bronchus. The condition is reversible, contingent on being relieved within a few days.

Publication types

  • Case Reports

MeSH terms

  • Bronchoscopy*
  • Cough / etiology
  • Down-Regulation
  • Dyspnea / etiology
  • Fever / etiology
  • Gentamicins / administration & dosage
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / drug therapy
  • Hypertension, Pulmonary / pathology
  • Lung / pathology*
  • Penicillanic Acid / administration & dosage
  • Penicillanic Acid / analogs & derivatives
  • Piperacillin / administration & dosage
  • Piperacillin, Tazobactam Drug Combination
  • Pneumonia / etiology
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / drug therapy
  • Pulmonary Embolism / pathology
  • Tomography, Emission-Computed, Single-Photon
  • Treatment Outcome
  • Ventilation-Perfusion Ratio

Substances

  • Gentamicins
  • Piperacillin, Tazobactam Drug Combination
  • Penicillanic Acid
  • Piperacillin