• Eur J Emerg Med · Aug 2004

    Case Reports

    The importance of clinical suspicion in diagnosing pulmonary embolism: a case of false-positive high probability radionuclide perfusion lung scan.

    • Marco Cei, Nicola Mumoli, Federica Mariotti, and Riccardo Pardelli.
    • Departments of Emergency Medicine, Ospedale Civile Livorno, Viale Alfieri, 37, 57124 Livorno, Italy. famcei@libero.it
    • Eur J Emerg Med. 2004 Aug 1; 11 (4): 234-6.

    AbstractThe 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.

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