title: The importance of clinical suspicion in diagnosing pulmonary embolism: a case of false-positive high probability radionuclide perfusion lung scan.
abstract: The accuracy of scintigraphic evidence of perfusion defects, even when classified as 'high probability' by matching with ventilation techniques or thoracic roentenograms is unsatisfactory when used without a pre-test clinical evaluation of probability. Although unusual, a complete or near-complete unilateral absence of perfusion in a lung with normal perfusion controlaterally must alert clinicians to the possibility of a false-positive result. In such instances, the administration of therapeutic dosages of fibrinolitic and antithrombotic agents (or even surgery) may lead to deleterious consequences. We report a patient with malignancy causing extrinsic narrowing of the pulmonary artery leading to a drastic impairment in the perfusion of an entire lung, compatible with, but not diagnostic of massive pulmonary embolism.
authors.affiliation: Departments of Emergency Medicine, Ospedale Civile Livorno, Viale Alfieri, 37, 57124 Livorno, Italy. famcei@libero.it
authors.forename: Marco
authors.initials: M
authors.lastname: Cei
authors.forename: Nicola
authors.initials: N
authors.lastname: Mumoli
authors.forename: Federica
authors.initials: F
authors.lastname: Mariotti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pardelli
mesh_terms: D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003287:Contrast Media; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media