Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Pulmonary Disease

Answer 2
  1. Perfusion lung scintigraphy. Because this pregnant patient with suspected PE has no known underlying lung disease and a normal chest radiograph, perfusion lung scintigraphy (performed without a ventilation study and often at half-dose of technetium 99m) is an appropriate initial test that has a low percentage of nondiagnostic scans.3 Although the fetus is exposed to slightly higher levels of radiation with pulmonary scintigraphy as compared with CTPA (0.11 mGy versus 0.01 mGy), this dose remains well below the established threshold of 50 mGy to avoid known fetal malformations, and this dose may be cut in half by requesting a half-dose of perfusion agent. Duplex ultrasonography is effective and safe in diagnosing DVT. It is most sensitive if leg symptoms are present, and it is less sensitive in pregnant patients, who often develop DVT in pelvic veins, which cannot be imaged by ultrasonography. Echocardiography is an effective tool to assess risk for shock or death in patients with PE, but it is insensitive as a diagnostic tool (sensitivity, 52%).4 CTPA is an acceptable test in pregnancy, but this modality exposes the mother to higher levels of radiation and may pose an unacceptably high risk of malignancy to proliferating maternal breast tissue. Because of this, CTPA is recommended only in cases when the mother has an underlying lung disease (eg, asthma, COPD) or when frontal chest radiography is abnormal. Invasive pulmonary angiography is not recommended as an initial diagnostic test because it has the highest risk of complications; however, it may be useful when less invasive tests are nondiagnostic and clinical suspicion for PE remains high.

    3. Scarsbrook AF, Bradley KM, Gleeson FV. Perfusion scintigraphy: diagnostic utility in pregnant women with suspected pulmonary embolic disease. Eur Radiol 2007 Mar 7; [Epub ahead of print].

    4. Bova C, Greco F, Misuraca G, et al. Diagnostic utility of echocardiography in patients with suspected pulmonary embolism. Am J Emerg Med 2003;21:180-3.

Click here to return to the questions


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 7/6/07 • kkj