V/P scan in diagnosis and follow-up of pulmonary embolism in 15-25-year-old females in relation to hormonal contraception use.
BACKGROUND
An analysis of medical records of young females who were examined in our department during a five-year period (2005-2009) on suspicion of pulmonary embolism (PE) in relation to hormonal contraception (HC).


METHODS
The patient sample included 86 young females aged 15-25 (mean 21) years who underwent a ventilation/ perfusion scintigraphy (V/P scan). Seventeen of them were examined repeatedly. Altogether, 114 scintigraphic examinations were performed. Lung perfusion scintigraphy was performed using a planar gamma camera (Mediso MB 9200) in 4 projections following 100 MBq 99mTc--MAA i.v. application with 81 mKr ventilation scintigraphy concurrently.


RESULTS
1. Among 57/86 (66%) patients on HC, 24 (42%) had scintigraphic signs of PE. 2. 11/57 (19%) of them had clinical signs of deep venous system thrombosis of the lower limbs that were confirmed by sonography. 3. Leiden mutation was found in 9/24 (37%) patients with PE. 4. Among 29/86 (34%) females not taking HC, PE was detected in only 3 patients (10%). 5. 10/17 (59%) repeatedly examined females had permanent post-embolic residual changes of lung perfusion.


CONCLUSIONS
In our group of patients who underwent a P/V scan, 42% of those on HC were diagnosed with PE on scintigraphy, compared to 10% of those not taking HC. Among the patients with PE, there were 10/24 (42%) young females with persistent post-embolic changes. Our study indicates that the well-known risk of venous thromboembolism related to the use of HC needs to be considered as a cause of PE even among very young females. In our experience, prevention of these life-threatening conditions in patients with a family history of venous thromboembolism consists of timely examination of their thrombotic profile and selection of appropriate contraception.
Department of Nuclear Medicine, General Teaching Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic. Daniela.Chroustova@vfn.cz
Daniela
D
Chroustova
Jozef
J
Kubinyi
Pavel
P
Jansa
Lenka
L
Veprekova
Jiri
J
Trnka
D000293:Adolescent; D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D005165:Factor V / Q000235:genetics; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging; D008168:Lung / Q000000981:diagnostic imaging*; D009154:Mutation; D055420:Perfusion Imaging / Q000379:methods; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000235:genetics; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D055815:Young Adult
D003278:Contraceptives, Oral, Hormonal; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C095381:factor V Leiden; D005165:Factor V