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Age: 90

Sex: Female

Indication: Chest pain

Radiotracer:

Perfusion: Tc99m MAA

Ventilation: aerosolized Tc99m DTPA

Save ("V")

Case #4


Findings

  • V/Q:
    • Large wedge-shaped perfusion and matching ventilation defects in the posterior left lung base
    • Rounded photopenic defect in the left upper lung on the LAO projection, corresponding to the pacemaker generator
  • CXR:
    • No radiographic evidence of acute cardiopulmonary disease
    • No radiographic findings corresponding to the above described defect
    • Spiculated left upper lobe nodule


Diagnosis

  • Low probability of PE by PIOPED I
  • Nondiagnostic by PIOPED II

Sample Report

Nondiagnostic for PE by PIOPED II.


Discussion


Images

PIOPED Criteria: reference [Naoyuki et al] VQ terminology: reference [Ziessman et al] VQ lung segments: reference Sostman and Gottschalk. Attenuation artifact associated with the patient's pacemaker, which results in a round area of photopenia in the upper lung (red arrow).



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References
  1. Naoyuki W, Jure F, Ozlem KN, Otakar K, Partha C, Surendra S, Keigo E, Maurizio D. Modified PIOPED criteria in combination with ventilation scintigraphic finding for predicting acute pulmonary embolism. World Journal of Nuclear Medicine 2015; 14.3.
  2. Sostman HD, Gottschalk A. Diagnostic Nuclear Medicine. 2nd ed.1, Williams & Wilkins 988:513.
  3. Ziessman, Harvey A, et al. Nuclear Medicine: the Requisites. 4th ed., Elsevier Saunders, 2014.

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