ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 2
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
The cardiac silhouette and pulmonary vasculature were both normal.
He was
noted to have bilateral pleural thickening that was obtained 6 months
earlier. There was however, an area of abnormal increased density
which was noted in the lingula.
There is a segmental size perfusion defect in the area of the
lingula that corresponds to the abnormality on the chest x-ray.
Several
smaller perfusion defects are noted in the periphery of both lungs.
There are multiple small areas of ventilation abnormality that are
present in both lung bases.
Ventilation/Perfusion scan reading:
This scan was called indeterminate because of the lingualar perfusion
defect that matched the chest x-ray abnormality.
A Left PA pulmonary angiogram revealed a possible clot in a lower
lung field artery. 
A selective angiogram of the area in question revealed a filling
defect within a lingular pulmonary artery.
Case assessment
This is a 58 year old man who presents with chronic exertional chest
pain, shortness of breath and wheezing.
The clinical presentation of pulmonary embolus may be misleading because the symptoms are often non-specific.
Over a three month period this gentleman was given the diagnosis
of coronary artery disease, asthma and esophageal disease. The
possibility of pulmonary embolus was not considered until it was
suggested on the chest radiograph.
Cardiac catheterization must be performed properly in order to be a reasonably sensitive test.
In order to effectively rule out the presence of a clot the
guidance of the perfusion scan is quite important.
The
angiographer should make use of this information to help decide which
vessel should be catherized and what radiographic projection should
be used. It is often necessary to obtain multiple projections and
subselective, magnified view.
Next Page | Previous Page | Section Top | Title Page