case_images: PMC8295940_01
case_images: PMC8295940_02
case_images: (a) CT show bilateral posterior ground-glass opacities and consolidation in the upper left lung lobe (lingula, blue arrows), (b) and (c) transversal, coronal and sagittal slices of ventilation (upper row) and perfusion (lower row). Ventilation is unevenly distributed in both lungs with areas of reduced/absent ventilation (blue arrows), more prominent on the right side and posterior lower lobe on the left side. A well delineated matched V/P defect is observed corresponding to CT consolidation change in the upper left lung lobe (lingula, dotted blue arrow). Perfusion is better preserved in areas of reduced/absent ventilation (reversed mismatch, dotted red arrows). Importantly, a diversion of perfusion from the apical part is observed (red arrow), of non-segmental character and not typical for PE, more on the right side.
case_images: 10.1177_11795484211030159-fig1.jpg
case_images: PMC8295940_02_10.1177_11795484211030159-fig1.jpg
case_images: fig1-11795484211030159
case_images: PE but a bilateral infiltration in the posterior part of the lower lobes and in the lateral part of the left upper lobe or lingula (Figure 1a). CRP was 12, WBC diff normal and LFTs mildly elevated. Prophylactic LMWH was administered and the patient was hospitalised. The functional defect of the reversed mismatch extended to 40 % of TLV and was more extended than the inflammatory changes seen on CT (Figure 1b and c). TLV. The total preserved lung function was estimated to be 35% (Figure 1b and c).