Related Experiment Video
Updated: Jun 25, 2026
Phase-Resolved Functional Lung MRI for Pulmonary Ventilation and Perfusion (V/Q) Assessment
Published on: August 9, 2024
Lung ventilation-perfusion scintigraphy in children on long-term parenteral nutrition
Paloma Pifarré1, Isabel Roca, Iñaki Irastorza
1Department of Nuclear Medicine, Hospital de la Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. palomapifarremontaner@yahoo.es
Insights
Pulmonary emboli (PE) are common in children receiving total parenteral nutrition (TPN). Ventilation-perfusion (V/Q) scans reveal a high prevalence of undiagnosed PE, indicating underdiagnosis in this population.
Area of Science:
- Pediatric Medicine
- Radiology
- Critical Care
Background:
- Pulmonary emboli (PE) are a significant complication in patients receiving total parenteral nutrition (TPN).
- Ventilation-perfusion (V/Q) scintigraphy is the standard diagnostic tool for PE in TPN patients.
- The prevalence of undiagnosed PE in pediatric TPN patients requires further investigation.
Purpose of the Study:
- To determine the prevalence of undiagnosed pulmonary emboli (PE) in children undergoing total parenteral nutrition (TPN).
- To assess the utility of ventilation-perfusion (V/Q) scintigraphy in diagnosing PE in this pediatric cohort.
Main Methods:
- Retrospective review of medical and imaging files for 64 pediatric patients on TPN who underwent V/Q scans between 1986 and 2004.
- Analysis included patient age, TPN duration, and comparison of PE prevalence with risk factors like TPN composition, bowel inflammation, and thrombophilic factors.
- Exclusion criteria included abnormal chest radiographs or symptoms at the time of V/Q scan.
Main Results:
- Abnormal V/Q scans were observed in 25 (39%) of 64 patients, with 29 PE episodes diagnosed.
- PE was diagnosed on the initial V/Q scan in 68% of affected patients.
- All investigated risk factors were statistically associated with an increased prevalence of PE.
Conclusions:
- Pulmonary emboli (PE) are frequently underdiagnosed in children receiving long-term total parenteral nutrition (TPN).
- Lung V/Q scintigraphy is a valuable diagnostic tool for PE in pediatric TPN patients, particularly those with a low pretest probability.
- Identifying and managing PE risk factors is crucial in pediatric TPN management.
Purpose:
Pulmonary emboli (PE) are one of the major complications associated with total parenteral nutrition (TPN). Ventilation-perfusion scintigraphy (V/Q) remains the most used test for the diagnosis of PE and follow-up of patients on TPN. The aim of our study was to demonstrate the high prevalence of undiagnosed PE in children on TPN.
Methods:
The medical and imaging files of 64 patients on TPN who underwent V/Q examinations covering the period of 1986-2004 were reviewed. Children were aged between 3.18 months and 21.6 years. TPN was started at birth (range 0-15 years). All children had a normal chest radiograph and no symptoms at the time of the V/Q scan. A comparative analysis between the prevalence of PE and risk factors (number of days per week with lipophilic content of the TPN, bowel inflammation and thrombophilic factors (protein C and S) was performed.
Results:
Of the 64 patients, 25 (39%) had an abnormal V/Q scan. A total of 29 PE episodes were diagnosed in all patients. Two children had three episodes of PE. The median age at PE diagnosis was 4.6 years. In 17 patients (68%) diagnosis was achieved on the first V/Q scan performed. PE was bilateral in 56% and unilateral in 44%. PE was the main cause of 2 out 15 recorded deaths. All risk factors were associated with an increase in PE prevalence by statistical analysis.
Conclusion:
PE is underdiagnosed in children on long-term TPN. Lung V/Q scintigraphy is useful in the diagnosis of PE in children with a low pretest probability.
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