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Key Image

Perfusion (left) and Ventilation (right) in the Anterior projection.

Key Findings

There are multiple large filling defects in the upper and lower lobes of both lungs on the perfusion scan. These are not matched on the ventilation images, and are considered large mismatched defects. There are no radiographic findings to account for the patient's mismatched perfusion defects (see CXR in Case Images). Compare the current study with the prior normal study (available in Case Images)

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Diagnosis

High Probability for Pulmonary Embolism

Discussion

Additional Discussion regarding pulmonary embolism in case #13 and #14

References / Resources

Additional Information:

1. Dahnert*: 533, V/Q: 1119
2. Primer*: V/Q: 639-641, 674. CT: 5, 47
3. Related Article:

   Sostman, HD. "Acute Pulmonary Embolism: Sens and Spec of Ven-Perf Scintigraphy in PIOPED II Study." Radiology Jan 2008, 246:941-946.

   Stein, PD. "Contrast enhanced multidetector spiral CT of the chest and lower extremities in the suspected acute pulmonary embolism: results of the PIOPED II." NEJM 2006, 354:2317-2327.

   The PIOPED Investigators. "Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the Pulmonary Embolism Diagonsis(PIOPED)". JAMA 1990, 263: 2753-2759.

   Wittram C. "How I do it: CT pulmonary angiography." AJR 2007, 188: 1255-1261.

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