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Central pulmonary embolism with normal ventilation/perfusion scan-diagnosis by nuclear pulmonary artery flow studies
R Hackbarth1, L Kuhns, A Sarnaik
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201.
Insights
Pulmonary embolism (PE) in children is rare but serious. A nuclear pulmonary flow study can diagnose severe PE even with a normal ventilation-perfusion scan, avoiding contrast angiography.
Area of Science:
- Pediatric critical care medicine
- Diagnostic imaging in pulmonology
- Nuclear medicine applications
Background:
- Pulmonary embolism (PE) is uncommon in children but carries a high mortality rate if undiagnosed.
- Prompt diagnosis of pediatric PE requires high clinical suspicion and effective diagnostic tools.
- Traditional ventilation-perfusion (V/Q) scans may not always detect central PE.
Observation:
- A case of severe central pulmonary embolism in a pediatric patient presented with a normal ventilation-perfusion scan.
- Dynamic imaging with a nuclear pulmonary flow study successfully identified the central pulmonary embolus.
- Contrast pulmonary angiography was not required for diagnosis in this case.
Findings:
- The traditional ventilation-perfusion scan can yield normal results in the presence of severe central pulmonary embolism.
- Nuclear pulmonary flow study with dynamic imaging is a valuable tool for detecting central pulmonary artery obstruction.
- This imaging modality can obviate the need for contrast pulmonary angiography in stable patients.
Implications:
- Highlights the limitations of V/Q scans in diagnosing pediatric PE.
- Emphasizes the utility of nuclear pulmonary flow studies in identifying central PE.
- Suggests a potential alternative to contrast angiography for stable pediatric PE cases, reducing risks.
Abstract:
Pulmonary embolism, although uncommon in children, occurs in as many as 104 per 100,000 pediatric patients. Undiagnosed and untreated pulmonary embolism has a high mortality rate; thus, a high index of clinical suspicion and reliable diagnostic modalities are necessary to ensure prompt and accurate diagnosis. We report the case of a patient with severe central pulmonary embolism with a normal ventilation-perfusion scan. The embolus was identified by a nuclear pulmonary flow study using dynamic imaging, which obviated the need for contrast pulmonary angiography. The traditional ventilation-perfusion scan may appear normal despite severe central pulmonary embolism. In this situation, early dynamic imaging is necessary to detect severe obstruction of the central pulmonary arteries. This approach may obviate the need for contrast pulmonary angiography in hemodynamically stable patients.