ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 21
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
She was transferred to this hospital one month after the inception of her symptoms with a differential diagnosis which included : costochondritis, lumbar muscle strain and urinary tract infection.
The chest radiograph done at this hospital revealed a right
pleural effusion shown best on the lateral view.
The perfusion scan revealed a subsegmental defect in the superior
basal segment on the right.
There were
multiple smaller defects along the lateral margin of the left lung.
The ventilation scan was normal.
The final
reading was intermediate probability of pulmonary embolus.
The pulmonary angiogram demonstrated an oblong defect which
extended into the proximal portions of both the middle lobe and lower
lobe arteries, consistent with the diagnosis of acute pulmonary
embolus. 
Repeat chest x-ray done 2 weeks later showed clearing of the
pleural effusion on the lateral view.
A repeat
perfusion scan done at the same time shows interval resolution of the
perfusion defects after treatment with heparin.
Case Assessment
This is a case of a 20 year old female whose only apparent risk
factor was oralcontraceptive and presented with:
1. This patientÕs initial V/Q scan at the outside hospital (not available) was read as low probability and the diagnosis of pulmonary embolus was therefore, dropped from the differential diagnosis list. It should be remembered the Òlow probabilityÓ category is less reproducible than either the normal or high probability categories and is therefore less useful to plan therapy. (RADIMAGE)
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