Clinical History
VENTILATION/PERFUSION LUNG SCAN:
This is a 17-year-old female with Down's syndrome, pulmonary hypertension, and shortness of breath. This
study is to evaluate for pulmonary embolic disease.
Technique
The patient was administered a single breath of 13 millicuries of 133 Xenon gas and wash-in, equilibrium,
and wash-out images were obtained. The patient was then administered an IV dose of 4 mm of
technetium-99m MAA and multiple planar as well as SPECT images were obtained.
Findings
Ventilation Scan:
The ventilation scan demonstrates rapid uptake of activity bilaterally. There are no ventilation defects
identified. There is mild retention of activity in the left base which can be seen with obstructive pulmonary
disease.
Perfusion Scan:
There is symmetric, somewhat inhomogeneous, uptake in bilateral lungs which is most likely secondary to
fewer particles entering the pulmonary circulation. No pleural-based or segmental defects are identified to
suggest pulmonary embolic disease. There is activity identified in the patient's liver, spleen, kidneys,
thyroid, and brain, consistent with a right to left shunt. Note is made of asymmetric cerebra blood flow with the
left cerebral hemisphere displaying more activity than the right.
Impressions
1. VENTILATION/PERFUSION LUNG SCAN DEMONSTRATING A MODERATE TO LARGE
RIGHT TO LEFT CARDIOPULMONARY SHUNT AS DESCRIBED ABOVE.
2. NO SEGMENTAL OR PLEURAL-BASED PERFUSION DEFECTS ARE IDENTIFIED IN THE
LUNGS. THIS PLACES THE PATIENT IN THE LOW PROBABILITY CATEGORY FOR
PULMONARY EMBOLIC DISEASE.
3. ASYMMETRIC PERFUSION OF THE BRAIN WITH GREATER ACTIVITY IDENTIFIED IN
THE LEFT CEREBRAL HEMISPHERE AS COMPARED TO THE RIGHT.
Comments
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