ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 15
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
His portable chest x-ray at the time of admission to this hospital
showed dense consolidation of the left lower lobe silhouetting the
left hemidiaphragm. 
An
endotracheal tube and a chest tube were in place. (MISCIMAGE)
The perfusion scan obtained on admission showed multiple lobar and
segmental perfusion defects.
The
ventilation was relatively normal in the areas of abnormal perfusion.
Ultrasound of the pulmonary arteries done as part of an
experimental protocol confirmed the presence of clot in the left main
pulmonary artery. 
Case Assessment
This is the case of a 62 year old farmer who suffered massive
injuries and was at bed rest for 3 weeks. He presented with
increasing hypoxemia and dyspnea.
1. High probability scans readings are reproducible because the
abnormality is severe and the perfusion defects are large.
The normal
scan category is also reproducible. (RADIMAGE) There is a much higher
level of disagreement among readers for any other category.
(REFERENCE) See section on ventilation/perfusion scanning.
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