PROXIMAL BRONCHIAL-CARCINOMA WITH HYPOXEM IA SECONDARY TO A RIGHT-TO-LEFT INTRAPULMONARY SHUNT - CORRECTION OF THE HYPOXEMIA FOLLOWING PNEUMONECTOMY

The authors report a case of a patient who was in hospital for a bronc hial cancer completely occluding the left superior and inferior lobar bronchi. Respiratory function tests showed: an FEV1 of 1.7 litres, FEV 1 (vital capacity ratio of 60%), a TLC of 76% of the predicted value a nd a PaO2 of 52 mm of mercury with an elevated alveolar arterial oxyge n gradient. The ventilation perfusion lung scan showed that the left l ung was not ventilated but was perfused. A left pneumonectomy was judg ed to have removed the cancer and enabled a correction of the hypoxaem ia. The authors recall the functional repercussions of absent ventilat ion of one lung by a proximal bronchial obstruction and the therapeuti c implications in the realm of neoplastic pathophysiology.