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High-Probability V/Q study for Pulmonary Embolus

Shogan PJS - MedPix (2008)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: High-Probability V/Q study for Pulmonary Embolus

History: 62 yo male with PMHx significant for prostate cancer treated with XRT, chronic renal insufficiency, and prior left lower extremity deep venous thrombosis presents with acute shortness of breath after being diagnosed with a right lower extremity deep venous thrombosis. Other Information: Using the Wells prediction rule for diagnosing pulmonary embolism, this patient had a score greater than 7, placing him at a high-pretest probability of having a pulmonary embolism.

Findings: V/Q study with 44 mCi Tc99m DTPA, aerosolized to deliver 1 mCi, and 8.8 mCi Tc99m macroaggregated albumin (MAA), demonstrates decreased counts in the apical, posterior, and anterior segments of the right upper lobe on the posterior perfusion image. Additionally, there are decreased counts in the lateral segment of the right middle lobe. These findings are also demonstrated on the RPO and LPO perfusion images. Additionally, best seen on the left lateral, anterior, and LAO perfusion images there are decreased counts in the apical posterior and anterior segments of the left upper lobe. The ventilation scan is normal. As there are at least 2 large mismatched perfusion defects without any ventilation abnormalities, and using the PIOPED II V/Q scan interpretation categories and criteria, these findings are most consistent with a high-probability V/Q scan. The corresponding chest radiograph does not show focal abnormalities. No secondary signs of embolism, such as pleural effusion, oligemia, or apparent hilar enlargement, can be seen.

Ddx: Differential Diagnosis of Conditions Associated with Ventilation-Perfusion Mismatch: Acute pulmonary embolus Chronic pulmonary embolus Other causes of embolism (drug abuse, iatrogenic) Bronchogenic carcinoma (other neoplasms) Mediastinal or hilar adenopathy with obstruction of pulmonary artery or veins Hypoplasia or aplasia of pulmonary artery Swyer-James syndrome (some cases) Post-radiation therapy Vasculitis

Dxhow: Characteristic Imaging appearance

No MeSH data available.


Lateral chest radiograph demonstrates no focal abnormalities.  No secondary signs of pulmonary embolism, such as pleural effusion, oligemia, or apparent hilar enlargement, can be seen.
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MPX2117_synpic41143: Lateral chest radiograph demonstrates no focal abnormalities. No secondary signs of pulmonary embolism, such as pleural effusion, oligemia, or apparent hilar enlargement, can be seen.


High-Probability V/Q study for Pulmonary Embolus

Shogan PJS - MedPix (2008)

Lateral chest radiograph demonstrates no focal abnormalities.  No secondary signs of pulmonary embolism, such as pleural effusion, oligemia, or apparent hilar enlargement, can be seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2117&req=5

MPX2117_synpic41143: Lateral chest radiograph demonstrates no focal abnormalities. No secondary signs of pulmonary embolism, such as pleural effusion, oligemia, or apparent hilar enlargement, can be seen.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: High-Probability V/Q study for Pulmonary Embolus

History: 62 yo male with PMHx significant for prostate cancer treated with XRT, chronic renal insufficiency, and prior left lower extremity deep venous thrombosis presents with acute shortness of breath after being diagnosed with a right lower extremity deep venous thrombosis. Other Information: Using the Wells prediction rule for diagnosing pulmonary embolism, this patient had a score greater than 7, placing him at a high-pretest probability of having a pulmonary embolism.

Findings: V/Q study with 44 mCi Tc99m DTPA, aerosolized to deliver 1 mCi, and 8.8 mCi Tc99m macroaggregated albumin (MAA), demonstrates decreased counts in the apical, posterior, and anterior segments of the right upper lobe on the posterior perfusion image. Additionally, there are decreased counts in the lateral segment of the right middle lobe. These findings are also demonstrated on the RPO and LPO perfusion images. Additionally, best seen on the left lateral, anterior, and LAO perfusion images there are decreased counts in the apical posterior and anterior segments of the left upper lobe. The ventilation scan is normal. As there are at least 2 large mismatched perfusion defects without any ventilation abnormalities, and using the PIOPED II V/Q scan interpretation categories and criteria, these findings are most consistent with a high-probability V/Q scan. The corresponding chest radiograph does not show focal abnormalities. No secondary signs of embolism, such as pleural effusion, oligemia, or apparent hilar enlargement, can be seen.

Ddx: Differential Diagnosis of Conditions Associated with Ventilation-Perfusion Mismatch: Acute pulmonary embolus Chronic pulmonary embolus Other causes of embolism (drug abuse, iatrogenic) Bronchogenic carcinoma (other neoplasms) Mediastinal or hilar adenopathy with obstruction of pulmonary artery or veins Hypoplasia or aplasia of pulmonary artery Swyer-James syndrome (some cases) Post-radiation therapy Vasculitis

Dxhow: Characteristic Imaging appearance

No MeSH data available.