The importance of clinical suspicion in diagnosing pulmonary embolism: a case of false-positive high probability radionuclide perfusion lung scan

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine
Marco CeiRiccardo Pardelli

Abstract

The accuracy of scintigraphic evidence of perfusion defects, even when classified as 'high probability' by matching with ventilation techniques or thoracic roentenograms is unsatisfactory when used without a pre-test clinical evaluation of probability. Although unusual, a complete or near-complete unilateral absence of perfusion in a lung with normal perfusion controlaterally must alert clinicians to the possibility of a false-positive result. In such instances, the administration of therapeutic dosages of fibrinolitic and antithrombotic agents (or even surgery) may lead to deleterious consequences. We report a patient with malignancy causing extrinsic narrowing of the pulmonary artery leading to a drastic impairment in the perfusion of an entire lung, compatible with, but not diagnostic of massive pulmonary embolism.

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Citations

Jun 30, 2009·European Journal of Nuclear Medicine and Molecular Imaging·M BajcUNKNOWN EANM Committee
Oct 6, 2010·Seminars in Nuclear Medicine·Marika BajcBjörn Jonson
Aug 22, 2017·Clinical Nuclear Medicine·Jonathan AlisLeonard M Freeman
Jul 8, 2010·Diagnostic Cytopathology·John P Crapanzano, Anjali Saqi
Aug 15, 2019·European Journal of Nuclear Medicine and Molecular Imaging·Marika BajcBjorn Jonson

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