Figure 4.

Imaging modalities and resection specimens from a single patient. (A) V/Q scan showing decreased perfusion with preserved ventilation in the posterior left upper lobe, the lateral left upper lobe, the lateral left lower lobe and small perfusion deficits in the right middle lobe. (B) Digital subtraction pulmonary angiography showing (R): multiple stenoses in the proximal segmental arteries of the lower lobe arteries (most pronounced basal-posterior), in the posterior segmental artery of the upper lobe and in the bifurcation of the upper lobe artery that bifurcates in the segmental branches to the apical and anterior segment. Wall-mounted thrombus material in upper lobar artery and in the posterior segmental artery of the upper lobe. Truncation of some arteries in the middle lobe. (L): stenosis proximal in the upper lobe artery with slight irregular outline of het proximal upper lobe artery. Proximal caliber variations in multiple segmental lower lobe arteries. Slight irregular outline van some lingular branches, with truncations of some of these branches. Truncation of some basal branches in the lower lobe. (C) Coronal MIP reconstruction of CTPA during late arterial phase, visualizing chronic PE and bronchial arterial hypertrophy. (D) Coronal iodine map imaging (CT-LSIM) demonstrating severe patchy perfusion defects. (E) Surgical resection specimens. R, right; L, left; MIP, maximum intension projection; CTPA, computed tomography pulmonary angiography; PE, pulmonary embolism; CT-LSIM, computed tomography lung subtraction iodine mapping.