ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 29
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
The portable chest radiograph shows a density in the posterior
basilar segment of the left lower lobe.
The perfusion scan demonstrated 2 perfusion defects in the left
lung. #1 is a subsegmental defect in the superior segment of the left
lower lobe 
and #2 is
a larger non-segmental defect in the left lower lobe.
A
ventilation scan could not be completed due to the patients
condition. The interpretation at the time was "Findings most likely
represent parenchymal or airway disease although superimposed PE
can't be excluded".
The initial venous injection into the femoral vein revealed clot
extending from the right renal vein into the inferior vena cava.
In
addition, there were filling defects in vessels leading to the right
lower lobe. 
The left
lung was normal.
Case Assessment
This was a 60 year old male who was predisposed to deep venous
thrombosis because of prolonged bed rest and an underlying
malignancy. He presentedwith dyspnea, anxiety, tachypnea,
tachycardia, and respiratory alkalosis.
1. The angiogram demonstrated multiple clots in the right lung in
the same area where the perfusion scan is essentially normal.
Although the perfusion scan is generally recognized as a sensitive test for pulmonary emboli, non-occlusive clots can be missed.
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