Skip to main content
PMC home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1988 Feb;148(2):167–170.

Perfusion Lung Scans Provide a Guide to Which Patients With Apparent Primary Pulmonary Hypertension Merit Angiography

Kenneth M Moser, Gregory T Page, William L Ashburn, Peter F Fedullo
PMCID: PMC1026053  PMID: 3348025

Abstract

There is hesitancy, based on the perceived risk, to do pulmonary angiography in patients believed to have primary pulmonary hypertension. Yet pulmonary hypertension due to major-vessel, chronic thromboembolism mimics primary pulmonary hypertension clinically and on standard laboratory tests. Because thromboembolic pulmonary hypertension is potentially remediable by thromboendarterectomy and primary pulmonary hypertension is not, differentiating between these disorders is essential. Angiography is required in patients with thromboembolic pulmonary hypertension to define the anatomic location of the thrombi. In evaluating perfusion lung scans of 110 patients with pulmonary hypertension to determine whether the scan might provide a guide to selecting those patients who merit angiography, no segmentalsize perfusion defects were noted on the scans of 64 patients with primary pulmonary hypertension, whereas all 46 patients with thromboembolic hypertension had one or more defects that were segmental in size or larger. These data indicate that a perfusion lung scan should be done in patients with pulmonary hypertension of uncertain cause and that those with one or more segmental or larger defects merit pulmonary angiography before being diagnosed as having primary pulmonary hypertension.

Full text

PDF
169

Images in this article

168Image
on p.168
168Image
on p.168
168Image
on p.168
169Image
on p.169
169Image
on p.169

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BALL K. P., GOODWIN J. F., HARRISON C. V. Massive thrombotic occlusion of the large pulmonary arteries. Circulation. 1956 Nov;14(5):766–783. doi: 10.1161/01.cir.14.5.766. [DOI] [PubMed] [Google Scholar]
  2. Cabrol C., Cabrol A., Acar J., Gandjbakhch I., Guiraudon G., Laughlin L., Mattei M. F., Godeau P., Grondin P. Surgical correction of chronic postembolic obstructions of the pulmonary arteries. J Thorac Cardiovasc Surg. 1978 Nov;76(5):620–628. [PubMed] [Google Scholar]
  3. D'Alonzo G. E., Bower J. S., Dantzker D. R. Differentiation of patients with primary and thromboembolic pulmonary hypertension. Chest. 1984 Apr;85(4):457–461. doi: 10.1378/chest.85.4.457. [DOI] [PubMed] [Google Scholar]
  4. DIMOND E. G., GONLUBOL F. Death following angiocardiography: report of two cases after administration of diodrast and neoiopax, respectively. N Engl J Med. 1953 Dec 17;249(25):1029–1031. doi: 10.1056/NEJM195312172492506. [DOI] [PubMed] [Google Scholar]
  5. Fishman A. J., Moser K. M., Fedullo P. F. Perfusion lung scans vs pulmonary angiography in evaluation of suspected primary pulmonary hypertension. Chest. 1983 Dec;84(6):679–683. doi: 10.1378/chest.84.6.679. [DOI] [PubMed] [Google Scholar]
  6. Fuster V., Steele P. M., Edwards W. D., Gersh B. J., McGoon M. D., Frye R. L. Primary pulmonary hypertension: natural history and the importance of thrombosis. Circulation. 1984 Oct;70(4):580–587. doi: 10.1161/01.cir.70.4.580. [DOI] [PubMed] [Google Scholar]
  7. Lisbona R., Kreisman H., Novales-Diaz J., Derbekyan V. Perfusion lung scanning: differentiation of primary from thromboembolic pulmonary hypertension. AJR Am J Roentgenol. 1985 Jan;144(1):27–30. doi: 10.2214/ajr.144.1.27. [DOI] [PubMed] [Google Scholar]
  8. Mills S. R., Jackson D. C., Older R. A., Heaston D. K., Moore A. V. The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series. Radiology. 1980 Aug;136(2):295–299. doi: 10.1148/radiology.136.2.7403500. [DOI] [PubMed] [Google Scholar]
  9. Moser K. M., Daily P. O., Peterson K., Dembitsky W., Vapnek J. M., Shure D., Utley J., Archibald C. Thromboendarterectomy for chronic, major-vessel thromboembolic pulmonary hypertension. Immediate and long-term results in 42 patients. Ann Intern Med. 1987 Oct;107(4):560–565. doi: 10.7326/0003-4819-107-4-560. [DOI] [PubMed] [Google Scholar]
  10. Moser K. M., Spragg R. G., Utley J., Daily P. O. Chronic thrombotic obstruction of major pulmonary arteries. Results of thromboendarterectomy in 15 patients. Ann Intern Med. 1983 Sep;99(3):299–304. doi: 10.7326/0003-4819-99-3-299. [DOI] [PubMed] [Google Scholar]
  11. Nicod P., Peterson K., Levine M., Dittrich H., Buchbinder M., Chappuis F., Moser K. Pulmonary angiography in severe chronic pulmonary hypertension. Ann Intern Med. 1987 Oct;107(4):565–568. doi: 10.7326/0003-4819-107-4-565. [DOI] [PubMed] [Google Scholar]
  12. Packer M., Greenberg B., Massie B., Dash H. Deleterious effects of hydralazine in patients with pulmonary hypertension. N Engl J Med. 1982 Jun 3;306(22):1326–1331. doi: 10.1056/NEJM198206033062203. [DOI] [PubMed] [Google Scholar]
  13. Perlmutt L. M., Braun S. D., Newman G. E., Oke E. J., Dunnick N. R. Pulmonary arteriography in the high-risk patient. Radiology. 1987 Jan;162(1 Pt 1):187–189. doi: 10.1148/radiology.162.1.3786760. [DOI] [PubMed] [Google Scholar]
  14. Rich S., Pietra G. G., Kieras K., Hart K., Brundage B. H. Primary pulmonary hypertension: radiographic and scintigraphic patterns of histologic subtypes. Ann Intern Med. 1986 Oct;105(4):499–502. doi: 10.7326/0003-4819-105-4-499. [DOI] [PubMed] [Google Scholar]
  15. Sabiston D. C., Jr, Wolfe W. G., Oldham H. N., Jr, Wechsler A. S., Crawford F. A., Jr, Jones K. W., Jones R. H. Surgical management of chronic pulmonary embolism. Ann Surg. 1977 Jun;185(6):699–712. doi: 10.1097/00000658-197706000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES