The Distribution of Extremity Blood Flow before and after Vagectomy in a Patient with Hypertrophic Pulmonary Osteoarthropathy

¹ Department of Surgery and Division of Nuclear Medicine, The Johns Hopkins Medicial Institutions, Baltimore, Maryland

A patient with hypertrophic pulmonary osteoarthropathy associated with adenocarcinoma of the left upper lobe was studied before and after suprahilar vagectomy by arm and lung scans following left brachial artery injection of labelled albumin microspheres, digital plethysmography and forearm arteriovenous oxygen differences. Preoperatively, the distribution of microspheres to the extremity beyond the level of the skeletal proliferative changes was decreased and a large portion of the microspheres bypassed the microcirculation of the extremity and appeared on the lung scan. After vagectomy, the distribution of microspheres to the hand was improved and few microspheres reached the lungs. In addition, the forearm arteriovenous oxygen difference increased following vagectomy without significant changes in digital flow. These studies suggest that the increased blood flow in extremities with hypertrophic pulmonary osteoarthropathy results from the development of arteriovenous shunts and that these shunts close following vagectomy.