ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 14
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
He felt well until 1 year age when he developed an acute episode of shortness of breath one morning. He was assessed by his local physician the same day. He could find nothing significantly wrong and was sent home on anti-inflammatory medication. He was hospitalized one week later because of persistent complaints of dyspnea on exertion.
A perfusion scan done at that time was read as high probability.
There are numerous segmental and subsegmental perfusion defect.
A
ventilation scan was not done. He was anticoagulated and sent home.
He presented to this hospital after one year of chronic shortness of breath for a reassessment. A cardiac echo showed evidence of pulmonary hypertension with an enlarged right ventricle and right atrium. Bilateral venography was normal.
His pulmonary function showed normal spirometry with a diffusing
capacity that was reduced (75%) of predicted His chest x-ray revealed
mild cardiomegally with enlarged central pulmonary arteries. The
chest radiograph suggested pulmonary artery hypertension.
A repeat
perfusion scan, done at the time of the current admission, showed
numerous segmental and subsegmental perfusion defects that were
unchanged from the scan done one year prior.
The
ventilation scan was normal.
The
diagnosis at that time was findings of pulmonary emboli, unchanged
from one year ago. No evidence of acute emboli.
Despite the above V/Q scan reading an angiogram was requested. The
angiogram showed multiple vessels with smooth narrowing consistent
with old emboli. No new clots were identified.
Case Assessment
This is a 57 year old farmer who presented with a past history of
varicose veins, acute shortness of breath followed by chronic dyspnea
for one year, pulmonary hypertension, high probability perfusion
scans that were unchanged over 1 year, and angiographic evidence of
old clots.
1. Sequential perfusion scans can be quite helpful when assessing
new or persistent symptoms related to pulmonary emboli.
2 . A single High probability ventilation/perfusion scan may not be a reliable indicator of acute emboli when the patient has a history of prior emboli. (REFERENCE)
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