Wartski M, Zerbib E, Regnard J F, Hervé P
Department of Nuclear Medicine, Marie Lannelongue Surgical Center, Le Plessis-Robinson, France.
J Nucl Med. 1998 Nov;39(11):1986-9.
We report on a patient with squamous cell cancer of the left lung who was first considered ineligible for surgery because of severe hypoxemia. A ventilation-perfusion scan showed "reverse" ventilation-perfusion mismatch, with 20% of the total lung perfusion going to the left lung, which showed no ventilation with radioactive aerosols. This pattern suggested that the hypoxemia was due to intrapulmonary functional shunting and could therefore be improved by surgical resection of the tumor. Balloon occlusion of the left pulmonary artery resulted in an immediate rise in PaO2, indicating a right-to-left intrapulmonary shunt. After left pneumonectomy, PaO2 levels were normal. This patient provides an example of dysregulation of the pulmonary hypoxic vasoconstriction response in a non-small cell lung cancer. Lung cancer patients with severe hypoxemia should undergo ventilation-perfusion scanning to look for reverse ventilation-perfusion mismatch suggestive of intrapulmonary functional shunting.
我们报告了一名左肺鳞状细胞癌患者，该患者最初因严重低氧血症被认为不适合手术。通气-灌注扫描显示“反向”通气-灌注不匹配，全肺灌注的20%进入左肺，放射性气溶胶显示左肺无通气。这种模式表明低氧血症是由于肺内功能性分流所致，因此可通过手术切除肿瘤来改善。左肺动脉球囊闭塞导致动脉血氧分压（PaO2）立即升高，表明存在右向左肺内分流。左肺切除术后，PaO2水平恢复正常。该患者为例证了非小细胞肺癌中肺缺氧性血管收缩反应失调。严重低氧血症的肺癌患者应进行通气-灌注扫描，以寻找提示肺内功能性分流的反向通气-灌注不匹配。
