Case Author(s): J. Philip Moyers, M.D. and Keith C. Fischer, M.D. , 12/5/95 . Rating: #D1, #Q3

Diagnosis: High likelihood ratio for pulmonary embolism

Brief history:

Shortness of breath


Initial perfusion images

View main image(vq) in a separate image viewer

View second image(vq). Initial ventilation images (portable)

View third image(pe). Perfusion images obtained the following day

View fourth image(xr). portable supine AP chest radiograph

Full history/Diagnosis is available below

Diagnosis: High likelihood ratio for pulmonary embolism

Full history:

36-year old woman with calf pain, shortness of breath, and chest pain which began two days ago.


Less than 2 mCi Tc- 99m DTPA aerosol by inhalation and 5.3 mCi Tc-99m MAA i.v.


Perfusion images obtained on 11-9-95 demonstrate multiple segmental perfusion defects throughout both lungs. Perfusion images obtained two days later demonstrate near total resolution of these multiple segmental perfusion defects. Interval treatment included intravenous urokinase performed secondary to marked cardiovascular compromise of the patient due to these multiple pulmonary emboli.


Pulmonary embolism (PE) is diagnosed in 1% of all hospitalized patients and seen in 15-60% of autopsies. There are 600,000 new cases per year. The classic clinical triad, which is seen in less than one-third of patients, includes hemoptysis, pleural friction rub, and thrombophlebitis. While the major cause of PE is deep venous thrombosis (DVT), only 10-30% of patients with fatal PE have symptomatic DVT. Chest radiographs are notoriously insensitive and nonspecific in clinically suspected pulmonary embolism. Ventilation-perfusion scintigraphy is the diagnostic test of choice.

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: vq014

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