Presentation
Shortness of breath and chest pain. Second trimester of pregnancy.
Patient Data
There is suboptimal contrast opacification of the pulmonary arterial tree. The contrast density is not adequate for an acceptable quality CTPA. While no central filling defects are demonstrated, pulmonary embolism cannot be excluded on the basis of this study.
No secondary features of right heart strain such as reflux of contrast into the liver or straightening of the interventricular septum. The pulmonary artery is of normal caliber.
The lungs are clear.
As the CTPA was considered suboptimal, a ventilation perfusion scan (VQ SPECT) was performed to further investigate for acute pulmonary embolism.
The VQ SPECT was performed at half dose without low dose CT to limit radiation dose.
Uniform tracer distribution throughout the lungs on both the ventilation and perfusion acquisitions. No ventilation perfusion mismatch to indicate pulmonary embolism.
Case Discussion
The risk of pulmonary embolism is increased in pregnancy and can be life-threatening in rare cases. Both CTPA and VQ SPECT can be performed in pregnancy with very low radiation dose to the foetus.
CTPA diagnostic quality can be compromised in pregnant patients due to the hyperdynamic circulation affecting the timing of the contrast bolus1. In cases where CTPA is considered suboptimal, a VQ SPECT can be performed for further investigation. Conversely, if a patient undergoes VQ SPECT and it is equivocal, CTPA can be performed subsequently.
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