Detection of Pulmonary Artery Stenosis After Single-Lung Transplantation by Quantitative Pulmonary Perfusion Scintigraphy

Quantitative pulmonary perfusion scintigraphy (QPPS) has few indications for evaluation of pre- and post-lung transplantation. QPPS is useful for preoperative regional assessment of pulmonary function. Post-transplantation lung scintigraphy has a prognostic value in detecting chronic rejection. Here we report the clinical implication of QPPS in a 36-year-old man with post-alveolar microlithiasis complicated lung-transplantation. The pulmonary function tests and repeat thoracotomy excluded corresponding ventilatory problems and surgical complications. Doppler echocardiography suggested elevated pulmonary artery (PA) pressure. QPPS revealed decreased perfusion of transplanted lung (geometric mean: 46.8%) compared to contra-lateral lung affected by severe alveolar microlithiasis indicating post-transplant pulmonary artery stenosis; the diagnosis was confirmed by pulmonary CT-angiography. The patient underwent a successful balloon angioplasty. Post-revascularization perfusion scintigraphy documented increasing graft blood flow (geometric mean; 51%). We conclude that QPPS may play a significant role in the assessment and follow-up of patients with complicated lung transplantation, including pulmonary artery stenosis.