Pulmonary perfusion scintigraphy in diagnosis and management of fibrosing mediastinitis

Pulmonary ventilation/perfusion (V/Q) scintigraphy is often used for the diagnosis of pulmonary embolism. However, it should be noted that the perfusion defect shown by pulmonary perfusion imaging is not the only manifestation of pulmonary embolism. Any disease that causes pulmonary vasculature stenosis and occlusion can cause pulmonary blood flow perfusion impaired. We report a case of fibrosing mediastinitis (FM) with pulmonary hypertension as a complication of pulmonary artery and pulmonary vein stenosis. Based on clinical symptoms, laboratory test and multiple radiographic findings, the diagnosis of FM was established. The patient underwent balloon dilation and stent implantation of right upper lobe pulmonary vein, as well as balloon dilatation of right upper lobe pulmonary artery, whose symptoms was immediately improved during the following investigation.