People including doctors always wonder which Medical Imaging is best to confirm or exclude the Medical condition in their mind. I am presenting an imaging technique known to all of you. ( an easy & straight forward short case – mainly for your info/discussion) This patient was referred to me 2 weeks ago. Male, 40+ years old.
Questions:-
1) What is this examination called?
2)Is it normal or can you see any abnormalities?
3) Would you like to do any other tests/examinations?
4) Name the symptoms the patient would have presented with? >
Seelan
News, Views and More from Batch'64, Faculty of Medicine, Colombo, SriLanka 
Thanks Seelan. You seem to be a busy and active radiologist. Good work.
1.CTPA
2.PE,Obese man with prominent breast fat and a density in the R chest/ Breast area . Significance.?
3.Ultrasound of lower extremity to exclude DVT. Thrombomphilia screen if F/H suggests
4.SOB, Pleuritic pains, Hypotension/ collapse.
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I shall stay in the background and let the experts tackle the problem. Very interested about the case though.
Nisantha
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My views are just guessing ..I have no clue but by means of assumptions with the the bare minimal medical knowledge.”
As Participation is the name of the game”
I have to guess that multiple branching shown n A is a form of Pulmonary ?Angiography
Ref: GoogleB shows abnormality in Pulmonary vessels
Pulmonary Embolism following in the footsteps of Eddie the Great Physician
Other tests?
Doppler
VQ
Phlebography
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Eddie you have hit the nail on the head very quickly. All the answers are correct – 100 %.( except that the patient is not obese & the density in right breast area is not unusual. You see this difference occasionally, especially in right handed people with some asymmetrical hypertrophy of Pect muscles).
Rani also got it correct.
Recently one of our batch mate discussed a “similar” case with me. That prompted me to post this case.
How do we investigate suspected pulmonary embolism – it depends on the requesting physician. Some do an isotope VQ scan, if the chest xray showed clear lungs & some do CTPA (CT pulmonary angiogram) straight away,unless the patient is not suitable for contrast injection.
I prefer CTPA.as it is more reliable esp when you can demonstrate a clot. For this you need a good CTPA with most of the contrast in the pulmonary arteries & prevent overlapping of contrast filled pul.veins. With advanced techniques, appropriate timing & fast low dose CT scanners with 3D facilities, we can now fulfil this.
The case I presented has clot in the right Pul.artery :- distal Intermediate & adjacent lower lobe branch. It is visible in the scan as filling defect.
I would like to find out the origin of the clot & would do other studies like colour Doppler for DVT, but the patient has been sent to the hospital for treatment. I will have to follow up from his doctor ( I am in private practice)
Thanks
PS: I notice that not many batch mates are interested in this type of quiz – may be boring for many!!!!
Sorry to have you bored.
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Thanks Seelan for the case presentation.I remained quiet as I had no clue !. We rely on experts like yourself to tell us what is going on.
Our OB physicians order mainly V/Q scan in pregnant population as contrast is an issue in pregnancy. Is it an absolute
contraindication ? We often see mothers near term pregnancy with increasing breathlessness and it is difficult to know whether it is physiological or pathological, particularly with increasing BMI in our patient population and the associated hypercoagulability in pregnancy.
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You are correct. Most order VQ scan.
More than contrast, although the radiation dose for the fetus is much lower in CTPA than VQ scan, radiation to maternal breast is much more in CTPA as the radiation is to the chest area.
Many doctors do 1) a chest Xray to see if they are clear. 2) US of lower limbs to look for DVT ( DVT is more common on the left side owing to compression of the left common iliac vein by the crossing right common iliac artery as well as the gravid uterus. Pelvic DVT is a problem to identify). 3) VQ scan. 4) In some cases end up doing CTPA
False positive diagnosis is worry!
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Thanks Seelan.You have not bored anyone.The case presentation was super in true teaching style.I liked it. Most of our colleagues would have known the answers but do not contribute to the discussion.Even the responses to our casual conversations are from the same few of around 6-8 people.The only time that there is a flurry of activity is on birthdays.I am sure we can make this more engaging with greater participation.As regards, Medicine related quizzes? I am not sure whether our colleagues are really interested as most are now in retirement and further away from active practice.I have deliberately stopped reading medicine and focus more on the arts and history.There are a lot more enjoyable things in Life than our profession.This is actually a plea for greater participation from our colleagues.We need your active participation.Warm Regards to all. Eddie.
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