Findings:

A CXR was normal. Lung scintigraphy (68k bytes) demonstrated near absent left lung perfusion. There were at least two full segment wedge-shaped perfusion defects in the right lung: anterior basal segment and lateral segment of the right middle lobe. Ventilation (72k bytes) was normal. The impression was high probability for pulmonary embolism.

Imaging Techniques

A ventilation/perfusion lung scan was obtained: 3.6 mCi of Tc-99m labeled MAA was injected intravenously with the patient in the supine position. Imaging was performed on a triple-headed camera in 8 projections (60 degree anterior oblique views are not shown) for 500,000 counts each. A 21 mCi Xe-133 ventilation study followed: posterior positioning (posterior and steep anterior obliques) with a 15 second first breath image followed by equilibrium and washout frames for a total of 5 minutes.

Hospital Course

The patient was started immediately on intravenous heparin and subsequently coumadin PO. He remained asymptomatic and was discharged home. A follow-up lung perfusion study (72k bytes) obtained 24 days after the initial scan showed essentially complete resolution of the perfusion abnormalities.

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J. Anthony Parker, MD PhD, Tony_Parker@bih.harvard.edu