Clinical History
The patient is a 74-year-old male with a history of CHF
and probable COPD. The patient has complaints of
shortness-of-breath. The study is being done in order
to rule out pulmonary embolus.
Technique
Chest X-ray:
Cardiomegaly is identified. There is bibasilar
atelectasis seen. No pleural effusion is identified,
although the right costophrenic angle is not included.
No pneumonia or pneumothorax are identified. There
is a decrease in vascular markings in the right upper
lobe.
Ventilation Scan:
The patient received a
single breath of 10
millicuries of xenon 133
gas. Inhalation,
equilibrium, and wash-out
images were obtained.
Ventilation views show
rapid and symmetric
uptake with rapid
symmetric wash-out of the
xenon gas. No ventilation
defect or air trapping is
identified.
Perfusion Scan:
The patient was
administered an IV dose of
5 millicuries of 99m Tc
MAA, and static and
SPECT images of the lungs
were obtained in multiple
projections. The perfusion
images demonstrate a large
perfusion defect including
the right upper and middle
lobes. There is also a
subsegmental defect
identified in the left
anterior upper lobe.
Findings
Impressions
THERE IS A LARGE PERFUSION DEFECT
IDENTIFIED IN THE RIGHT UPPER AND MIDDLE
LOBES THAT IS NOT MATCHED WITH THE
VENTILATION SCAN OR CHEST X-RAY. THERE IS
ALSO A SUBSEGMENTAL DEFECT IDENTIFIED IN
THE LEFT ANTERIOR UPPER LOBE THAT IS NOT
MATCHED WITH THE VENTILATION SCANS OR
CHEST X-RAY. THIS PLACES THE PATIENT AT A
HIGH PROBABILITY FOR A PULMONARY EMBOLUS.
Comments
Click here if you
would like to view a cine of the 3D volume rendered
perfusion lung SPECT. This is a quicktime movie
file.
Click here if you
would like to view a cine of the ventilation dynamic
study. This is a quicktime movie file.