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(Chest. 1996;110:392-394.)
© 1996 American College of Chest Physicians

Can Pulmonary Angiography Be Limited to the Most Suspicious Side if the Contralateral Side Appears Normal on the Ventilation/Perfusion Lung Scan?

Data From PIOPED

Alexander Gottschalk MD, FCCP1; Paul D. Stein MD, FCCP2; Jerald W. Henry MS2; and Bruce Relyea MD2

1 From the Michigan State University, East Lansing
2 From the Henry Ford Heart and Vascular Institute, Detroit

Purpose: The purpose of this investigation was to determine the frequency of pulmonary embolism (PE) in a single lung that showed a normal ventilation/perfusion (V/Q) lung scan when the V/Q scan on the contralateral side was interpreted as non-high-probability for PE.

Methods: Data are from the national collaborative study Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). PE was diagnosed or excluded in all lungs by pulmonary angiography.

Results: Single lungs with no V/Q abnormalities, when the V/Q scan on the contralateral side was interpreted as non-high-probability for PE, showed PE in 2 of 19 (11%) (95% confidence interval [CI], 1 to 33%). If PE was excluded by angiography on the side of the abnormal V/Q scan, then PE on the side of the normal V/Q scan was shown in only 1 of 19 (5%) (95% CI, 0 to 26%).

Conclusion: A normal V/Q scan in a single lung, when the contralateral lung was interpreted as non-high-probability for PE, did not completely exclude PE on the apparently normal side. In such lungs, the probability of PE was in the range of low-probability interpretations. If the pulmonary angiogram showed no PE on the side of the abnormal V/Q scan, the probability of PE on the side of the normal V/Q scan satisfied the definition of very low probability for PE. This observation in angiogram should be bilateral.

Key Words: deep venous thrombosis • pulmonary embolism • thromboembolic disease • ventilation/perfusion lung scan

Submitted on December 4, 1995
Accepted on February 23, 1996




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[Abstract] [Full Text]


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