Usefulness of Nuclear Medicine Scintigraphic Ventilation-Perfusion (V/Q) Scanning of the Lung in Diagnosis of Pulmonary Embolism: A Case Report
Article Sidebar
Main Article Content
Abstract
Pulmonary embolism (PE) is a life- threatening condition. The clinical manifestations are rather nonspecific. Typical symptoms are sudden dyspnea and chest pain, which also can be the presenting complaints in other various conditions. Other signs and symptoms such as hemoptysis, cardiac arrhythmia, syncope, seizure etc. occur less frequently and are not unique to PE either. The case was a 32 year-old woman with underlying asthma and steroid abuse, presenting with sudden chest pain and generalized tonic-clonic seizure. Cerebral computerized tomography (CT) was normal. Arterial blood gas showed hypoxemia and examination revealed left leg edema. Venoscintigraphy and perfusion lung scan diagnosed deep vein thrombosis and PE. She was markedly improved because of the early diagnosis and treatment. Pulmonary angiography is a gold standard for diagnosis of PE but is invasive. There are other alternative tests e.g. CT angiography, D-dimer assay however venoscintigraphy and V/Q lung scanning are the safest and most sensitive non-invasive test in the diagnosis.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Dejan K, Stefek G. Pulmonary thromboembolism presenting as epileptiform generalized scizure. Eu J Emerg Med 2004; 11: 346-7.
Tintinalli JE, Kelen GD, Stapczynski JS. Emergency medicine: a comprehensive study guide. Sth ed. Philadelphia: McGraw-Hill; 2000.
Murray IP, Ell PJ. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. New York: Churchill Livingstone; 1998. p.29-46.
Baker WF. Diagnosis of deep venous thrombosis and pulmonary embolism. Med Clin N Am 1998; 82, 459-74.
Sostman HD, Coleman RE, DeLong DM, Newman GE, Paine S. Evaluation of revised criteria for ventilationperfusion scintigraphy in patients with suspected pulmonary embolism. Radiology 1994; 193: 103-7.
The prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) Investigators. Value of the ventilation-perfusion scan in acute pulmonary embolism. JAMA 1990; 263: 2753-9.
Van Beek EJ, Kuyer PM, Schenk BE, Brandies DP, ten Cate JW, Buller HR. A normal perfusion hung scan in patients with clinically suspected pulmonary embolism. Frequency and clinical validity. Chest 1995; 108:170-3.
Meyervitz MF, Mannting F, Polak JF, Goldhaber SZ. Frequency of pulmonary embolism in in patients with low-probability lung scan and negative lowerextremity venous ultrasound. Chest 1999; 115: 980-2.
Wong WY, Ng DCE, Ang ES, Goh ASW, Sundran FX. Intermediate probability lung scan (IPLS): Retrospective review of 82 cases. Singapore Med J 2001; 42: 450-4.
Hildner FJ, Ormond RS. Accuracy of the clinical diagnosis of pulmonary embolism. JAMA.1967; 202:567-70.
Sasahara AA, Sharma GV, Barsamian EM, Schoolman M, Cella G. Pulmonary thromboenbolism diagnosis and treatment. JAMA 1983; 249: 2945-50.
tein PD, Athanasoulis C, Alavi A, Greenspan RH, Hales CA, Saltzman HA, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation. 1992; 85: 462-8.
Henry JW, Relyea B, Stein PD. Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest 1995; 107: 1375-8.
Remy-Jardin M, Remy J, Watinne L, Giraud F. Central pulmonary thromboenbolism: diagnosis with spiral volumetric CT with the single-breath-hold technique: comparison with pulmonary angiography. Radiology 1992; 185: 381-7.
Van ErKel AR, van Rossum AB, Bloem JL, Kievit J, Pattynama PM. Spiral DT angiography for suspected pulmonary embolism: a cost-effectiveness analysis. Radiology 1996; 201: 29-36.
Goodman LR, Lipchik RJ, Kuzo RS. Acute pulmonary embolism: the role of computed tomographic imaging. Thorac imaging 1997; 12: 83-6.
Stein PD, Henry JW, Gottschalk A. Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism.relation of interpreter agreement to the order of the involved pulmonary arterial branch. Radiology 1999; 210: 689-91.
Egermayer P, Town GI, Turner JG, heaton DC, Mee AL, Beard ME. Uscfulness of D-dimer, blood gas and respiratory rate measurements for excluding pulmonary embolism. Thorax 1998; 53: 830-4.
Value of the ventilation-perfusion scan in acute pulmonary embolism, Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED investigators. JAMA 1990; 263: 2753-9.