The scintigraphic findings in a rare case of a unilateral matched ventilation perfusion defect, Swyer-James (Macleod's) syndrome, are presented. A 40-year-old man underwent ventilation/perfusion imaging for acute onset of dyspnea. The scan showed markedly diminished ventilation, vascular flow, and perfusion unilaterally on the left hemithorax. Chest radiography showed hyperlucency of the left lung. Pulmonary angiography showed left-sided hypovascularity, and the CT scan of the chest showed apical bullae and peribronchial thickening of the left lung. Ventilation/perfusion imaging and other radiologic assessment, along with the patient's medical history, confirmed the diagnosis of the Swyer-James syndrome. This condition should be considered as a differential diagnosis in a patient with unilaterally matched ventilation/perfusion deficits without an obvious etiology.

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PubMed1996

Effects of myocardial viability assessment with positron emission tomography on clinical management and patient outcomes.

OBJECTIVE: To evaluate the effects of myocardial viability assessment with positron emission tomography on cardiac revascularization decision-making and consequential outcomes of patients with multivessel coronary artery disease. METHODS: Thirty-three patients with multivessel coronary disease and heart failure were studied in this series, using 13NH for myocardial perfusion and F-18-deoxy-glucose for myocardial metabolism. Viable myocardium (mis-matched perfusion-metabolism) was visually and quantitatively analyzed in anterior, apical, septal, inferior, and lateral segments of the left ventricle. Left ventricular ejection fraction (LVEF) was also measured with first-pass radionuclide angiocardiography. RESULTS: Based on the assessment of myocardial viability, 19 patients (group A) with sufficient viable myocardium underwent revascularization (coronary bypass graft and/or angioplasty), and 14 patients (group B) without sufficient viable myocardium received conservative medical treatment. During an average of 17-month follow-up, there were 2 (10.5%) deaths in group A and 2 in group B (14.3%) deaths (P > 0.5). Patients with revascularization showed significantly improved average LVEFs post-revascularization, without revascularization procedure-related mortality; patients with medical treatment had an initial average LVEF of 25% and class II-III (NYHA) average cardiac function with a survival rate of 86% in average, which was better than that reported in literature. CONCLUSION: Positron emission tomography is useful in myocardial viability assessment for cardiac revascularization decision-making through precisely selecting suitable patients for revascularization and avoiding operations on those who will not benefit, which results in promising effects on outcomes of patients with multivessel coronary disease and severe left ventricular dysfunction.

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