Hypoxemia Unassociated With Anatomic Shunting in Pulmonary Disease

Abstract

Forty-two patients with various pulmonary abnormalities had anatomic right-to-left shunting determined during perfusion lung scintigraphy. In no instance was an abnormal shunt detected despite some severe pulmonary vascular or airway abnormalities. Twelve patients had arterial blood gas determinations performed within 24 hours of scintigraphy; several were hypoxemic despite the lack of abnormal shunting. Ventilation-perfusion mismatching or physiologic shunting was the probable cause of hypoxemia in those cases. Anatomic shunting undoubtedly occurs in some pulmonary abnormalities but should not be evoked offhandedly as a proximate cause of hypoxemia in all cases.

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