Case 2:
78 year old female presents with chest pain and SOB. She has a history of COPD with
interstitial pulmonary fibrosis diagnosed on chest x-ray 9/30/09.
Technique: AP chest x-ray with nuclear medicine VQ scan. Ventilation imaging was
done in multiple projections using 54.2 mCi of technetium 99m DTPA aerosol. Perfusion
imaging was done in identical projections using 4.5 mCi of technetium 99m MAA.
Impression?.........
Findings: There is markedly abnormal ventilation and perfusion bilaterally. There are
numerous segmental, large subsegmental and small subsegmental ventilatory and
perfusion defects in both lungs. The appearance is consistent with severe emphysema.
Although all of the ventilation and perfusion defects appear to be matched, the large
number of abnormalities carries an intermediate probability of pulmonary embolism.
Impression: Severe COPD. Intermediate probability of pulmonary embolism.
Patient represented 5 days later with increased SOB, hypoxia. AP chest x-ray was
completed. AP chest x-ray showed the following:
FINDINGS: Left pleural effusion is slightly larger than October 30 but new from 2008.
New right lung base opacity is probably from a new small pleural effusion. The cardiac
silhouette remains slightly enlarged. There is slight vascular congestion as before. No
pneumothorax. The left CP angle and left diaphragm are now more obscured such that
coexistent new compressive atelectasis and/or pneumonia cannot be excluded.
IMPRESSION: Larger left and new small right pleural effusions; New left lower lobe
compressive atelectasis and/or pneumonia; Persistent cardiomegaly and vascular
congestion possibly representing chronic CHF