The Fissure Sign: Its Multiple Causes

Ae, James; Jj, Conway; Ch, Chang; Cooper, Malcolm; Ri, White; Hw, Strauss

doi:10.2214/ajr.111.3.492

Cited by 13 publications

(4 citation statements)

References 12 publications

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“…The stripe sign 19 b. The fissure sign 69,70 c. Segmental contour pattern 71 d. Large pleural effusions with matched V/Q findings and no other V/Q mismatches 21 e. Radiographic densities with matched V/Q findings in upper or mid-lung zone 20 f. Perfusion scan better than abnormal chest radiograph g. V defects worse than Q defects: reverse mismatch 23 3. Stratification of patients who may or may not have underlying cardiopulmonary disease has enhanced interpretation 4.…”

Section: The Pioped II Studymentioning

confidence: 99%

The Current and Continuing Important Role of Ventilation-Perfusion Scintigraphy in Evaluating Patients With Suspected Pulmonary Embolism

Freeman

Stein

Sprayregen

et al. 2008

Seminars in Nuclear Medicine

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Section: The Pioped II Studymentioning

confidence: 99%

The Current and Continuing Important Role of Ventilation-Perfusion Scintigraphy in Evaluating Patients With Suspected Pulmonary Embolism

Freeman

Stein

Sprayregen

et al. 2008

Seminars in Nuclear Medicine

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“…18 The stripe, fissure, and reverse defect signs have now improved the negative predictive value. 19,20 Lastly, the PISAPED classification noted that perfusion defects out of proportion to infiltrates on chest imaging were much more suspicious for PE, especially if they were wedge shaped, and conversely perfusion defects smaller than what was suspected from the infiltrates were less likely due to PE. 21 The wording of V/Q interpretation is also changing to a trinary model (No PE, Yes PE, or nondiagnostic).…”

Section: Discussionmentioning

confidence: 99%

Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

Weinberg

Chang

et al. 2018

J Intensive Care Med

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Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

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“…This consists of a linear band of decreased perfusion corresponding to either the major or minor lung fissures. Although originally described as a possible PE, experience has shown that it is much more likely to be associated with pleural effusions or chronic parenchymal disease [17].…”

Section: Fissure Signmentioning

confidence: 99%

Ventilation-perfusion (V/Q) lung scintigraphy: a long journey to a renewed position of prominence in diagnosing pulmonary embolism

Silva

Shah

Freeman

2014

Clin Transl Imaging

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The ventilation-perfusion (V/Q) lung scan has traveled a long, circuitous path since its introduction for the diagnosis of pulmonary embolism (PE) in the 1960s. Its initial credibility was damaged following the publication of the PI-OPED study in 1990 and the emergence of computed tomographic pulmonary angiography (CTPA) in the mid-1990s. A considerable number of advances in both methodology and image interpretation have helped to restore the credibility of V/Q. There has also been considerable concern over the large radiation burden associated with CTPA. The issue of overdiagnosis and overtreatment of small PEs has also received a lot of attention. Although CTPA diagnoses more of these smaller PEs than V/Q, follow-up ''outcomes'' data show that they do not require treatment. The false-negative rates for both procedures are approximately 1 % and not significantly different from one another. Finally, a change from traditional probability interpretations to a simpler and similarly accurate trinary system has made V/Q scintigraphy interpretations easier to understand for the referring clinician.

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The Fissure Sign: Its Multiple Causes

Cited by 13 publications

References 12 publications

The Current and Continuing Important Role of Ventilation-Perfusion Scintigraphy in Evaluating Patients With Suspected Pulmonary Embolism

The Current and Continuing Important Role of Ventilation-Perfusion Scintigraphy in Evaluating Patients With Suspected Pulmonary Embolism

Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

Ventilation-perfusion (V/Q) lung scintigraphy: a long journey to a renewed position of prominence in diagnosing pulmonary embolism

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