Case Author(s): J. Wallis , 7/21/95 . Rating: #D1, #Q4

Diagnosis: Pulmonary embolism.

Brief history:

Acute onset of shortness of breath.


Pefusion images.

Top Row: Post, RPO, R lateral;

Bottom Row: LPO, L lateral, Anterior

View main image(pe) in a separate image viewer

View second image(vq). Ventilation images. Sequential 1 minute frames.

The chest radiograph (not shown) was normal.

Full history/Diagnosis is available below

Diagnosis: Pulmonary embolism.

Full history:

Elderly woman who presented with acute gastrointestinal bleeding approximately 3 weeks ago, now status post colectomy who was apparently doing well postoperatively, with sudden onset of tachypnea, decreased oxygen saturation, and decreased blood pressure.


The ventilation study is normal.

The perfusion images are markedly abnormal, with nearly absent perfusion to over 60% of the left lung and over 80% of the right lung. The residual perfusion is noted in the superior segment of the right lower lobe as well as a portion of the right middle lobe. On the left, residual perfusion is to the anterior segment of the left upper lobe as well as the posterior segment of the left upper lobe and lingula.


The markedly abnormal perfusion study, along with a normal ventilation study and chest radiograph, suggests massive pulmonary embolism. Even the areas which are best perfused may not be completely free of emboli, as partial occlusion may be present.

Given the patients hypotension, lytic agents should at least be considered in the patient's management.


An IVC filter was placed in the patient.

Major teaching point(s):

Within the "high" category, there is still a wide range of scintigraphic appearance. This study has a very high likelihood ratio for pulmonary embolism; both the level of diagnostic certainty and the extent of disease should be communicated to the referring physician.

ACR Codes and Keywords:

References and General Discussion of Ventilation Perfusion Scintigraphy (Anatomic field:Lung, Mediastinum, and Pleura, Category:Organ specific)

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Case number: vq010

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