Bronchopleural fistula mimicking chronic obstructive lung disease on 133Xe scan.

A 56-y-old woman with a history of non–small cell lung cancer presented with a persistent left pneumothorax and a left bronchopleural fistula after bronchial balloon occlusion. A ventilation–perfusion scan using 133Xe and 99mTc-macroaggregated albumin (MAA) was requested to evaluate for possible lung reduction surgery. With 428.46 MBq (11.58 mCi) of 133Xe gas, ventilation images were acquired in the posterior projection during a single breath-hold in the equilibrium and washout phases. Regions of interest were drawn around the lungs to generate ventilation time–activity curves. Then, 162.06 MBq (4.38 mCi) of 99mTc-MAAwere injected intravenously and 8 standard projections of the lungs were acquired. Regions of interest were drawn around the lungs to calculate differential perfusion.