Abstract
Because alveolar hypoxia causes reflex vasoconstriction, areas of absent ventilation on lung scans usually are accompanied by matching perfusion defects. Perfusion of nonventilated lung, or reverse mismatch, has been described in a variety of conditions, including bronchial obstruction, atelectasis, and pneumonia (1-3), but not in pulmonary embolism. In this patient, a reverse mismatch involving almost the entire left lung was associated with extensive emboli to the opposite lung. It is likely that the increased vascular resistance produced by the emboli forced blood flow into the left lung, overcoming hypoxic vasoconstriction
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