Angiography of pulmonary emboli: digital studies and balloon-occlusion cineangiography

Abstract

V/Q scans also was studied. Emphasis on the value of digital pulmonary arteriography and scintigraphy-guided peripheral balloon-occlusion cineangiography in a total of 1 1 8 selected patients is the substance of this report. Materials and MethodsWe selected 1 18 patients suspected of harboring pulmonary emboli for investigation. All had radionuclide V/Q scans except for 20 patients who had massive bilateral diffuse pneumonitis, severe bilateral pulmonary edema, or marked emphysema with bullae. In these 20 patients we believed that the V/Q scan would not be of diagnostic significance. The remaining 98 patients had radionuclide V/Q scans that were interpreted as high, intermediate, or low probability according to the classification set forth by McNeil [4]. There were 38 with high probability, 40 with intermediate, and 20 with low probability. Although patients with an intermediate-probability scan are customarily evaluated by pulmonary arteriography [5], those with a high-or low-probability scan are not studied routinely with arteriography. In some instances, however, high-and low-probability patients may be evaluated by arteriography at our university when there are other clinical or laboratory factors that conflict with the presence (high probability) or absence (low probability) of pulmonary occlusion [6]. Hence, in all these patients with high or low probability, selection for angiographic evaluation was based on various clinical or laboratory factors, rather than the V/Q scan findings. Important to recognize is that in our series, we have been performing balloon-occlusion pulmonary cineangiography for about 4 years (78 patients), whereas digital pulmonary arteriography has been used for 2 years (40 patients), with the latter being performed only on cooperative patients who were capable of holding their breath 8-10 sec to allow appropriate serial films. Downloaded from www.ajronline.org by 18.236.198.91 on 05/10/18 from IP address 18.236.198.91.

Digital venous angiography in the diagnosis of pulmonary thromboembolism

“…As catheter design and catheterization techniques improved, the trend moved toward more selective and even balloon-occlusion injections in suspected areas, with very low morbidity and mortality [3,4,6,10]. The angiographic diagnosis of pulmonary thromboembolism can at times prove to be a very difficult task, especially in those cases of smaller emboli in distal pulmonary artery branches, which at times require subselective injections as well as magnification techniques [S].…”

Die Ballon-Okklusionsangiographie der Pulmonalarterien bei chronischer pulmonaler Hypertonie

“…Erste Publikationen reichen in die späten Dreißigerjahre zurück (Robb und Steinberg, 1938 Lungenembolie der Blattfilm-Technik mindestens gleichwertig ist (Smith et al, 2002;Johnson et al, 1998;Hagspiel et al, 1998;van Beek et al, 1996). Material- (Wilson und Bynum, 1976;Bynum und Wilson, 1979;Ferris et al, 1984;Greene et al, 1983;Wilson et al, 1993 Radiographien (Wilson und Bynum, 1976;Bynum und Wilson, 1979). (Fedullo et al, 2001).…”

Role of Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

“…7,18 -20 The clinical significance of isolated subsegmental pulmonary emboli also is unclear, especially in patients without evidence of DVT or cardiopulmonary dysfunction. Although many clinicians still hold pulmonary angiography as the gold standard, balloon occlusion studies have shown that even pulmonary angiography can miss subsegmental PE 21,22 and interobserver agreement is poor (13% to 66%). 18,23,24 One study comparing thin collimation (1 mm) CTPA and pulmonary angiography in a cast porcine model showed no statistical difference in sensitivity between the two modalities at the subsegmental levels (each 87%).…”