ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 7
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
The AP portable chest x-ray obtained on the same day as his
ventilation perfusion scan was read as normal.
The perfusion scan revealed 2 segmental defects. One in the apical
segment of the right upper lobe and one involving the posterior
segment of the left lower lobe.
The breath hold images of the ventilation scan revealed an area of
decreased ventilation in the left lower lobe with retention of
radiotracer during the washout phase.
The scan
wasread as intermediate probability with one matched and one
mismatched area. An angiogram was suggested
The angiogram was scheduled for the next day and included
selective injections of both the left lower and right upper lobes.
Both injections were normal.
The
angiographer noted areas of linear atelectasis in the left lower lobe
on fluoroscopy and a repeat chest radiograph was ordered.
This
confirmed the areas of linear atelectasis. In retrospect the first
film 3/7/92 showed atelectasis of the entire left lower lobe with a
silhouetted left hemidiaphragm.
Case Assessment
This is a 57 year old male with dyspnea and post op atelectasis that
mimicked a pulmonary embolus
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