Case Author(s): Sarah Reimer, MD and Tom R. Miller, MD, PhD , 02/02/99 . Rating: #D4, #Q4

Diagnosis: tumor embolism

Brief history:

Pt. developed shortness of breath following a liver biopsy.


Ventilation images

View main image(vq) in a separate image viewer

View second image(vq). Perfusion images

Full history/Diagnosis is available below

Diagnosis: tumor embolism

Full history:

The patient is a 73-year-old male who had had an IVC filter placed five years prior to this study. An ultrasound examination demonstrated a liver mass, with biopsy revealing hepatocellular carcinoma. The patient experienced progressive shortness of breath around this time.


The comparison chest radiograph (not shown) demonstrated hyperinflation without infiltrate or pleural effusion. The ventilation images demonstrate mild air trapping in the upper lobes. The perfusion images demonstrate multiple splinter-like, pleural based perfusion defects.


Metastatic tumor is an uncommon cause of pulmonary embolus, and the diagnosis is usually made post-mortem. Diagnosis may be made pre-mortem by lung biopsy.

In contrast to embolic clot, which generally produces segmental defects on perfusion scintgraphy, embolic metastases generally produce very small, splinter-like peripheral defects. These may not be seen on pulmonary angiography. Pulmonary angiography or chest radiograph typically only show pulmonary artery enlargement due to severe pulmonary artery hypertension.


The patient expired within days of this examination. Autopsy revealed diffuse tumor embolism throughout both lungs.

ACR Codes and Keywords:

References and General Discussion of Ventilation Perfusion Scintigraphy (Anatomic field:Lung, Mediastinum, and Pleura, Category:Neoplasm, Neoplastic-like condition)

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Case number: vq033

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