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Pulmonary hypertension secondary to left-sided heart disease: a cause for ventilation–perfusion mismatch mimicking pulmonary embolism

Division of Medical Imaging, Flinders Medical Centre, Bedford Park, Adelaide SA 5042, Australia

View larger version (57K): [in a new window]   Figure 1. Ventilation–perfusion lung scan shows symmetrical, large, non-segmental perfusion defects in the lower zones, with relatively normal ventilation. Anterior, posterior, and right and left lateral images are presented. Ventilation study: 99Tcm technegas; perfusion study: 99Tcm MAA.

View larger version (122K): [in a new window]   Figure 2. Erect posteroanterior chest radiograph shows gross cardiomegaly with distended upper lobe vessels. There is no evidence of pleural effusion.

View larger version (81K): [in a new window]   Figure 3. CT pulmonary angiogram (a) at the level of the aortic arch, showing enlarged upper lobe arteries, and (b) at the level of the left pulmonary artery, where no filling defect is seen in the central pulmonary arteries.