Pulmonary embolism: prediction of the usefulness of initial ventilation-perfusion scanning with chest radiographic findings.

Abstract

PURPOSE: To evaluate the usefulness of ventilation-perfusion scanning when chest radiographic findings are abnormal to decide which patients should initially undergo angiography because of suspected pulmonary embolism. MATERIALS AND METHODS: The records of 951 patients who underwent examination between April 1, 1992, and August 24, 1993, were reviewed, and the results of ventilation-perfusion scanning and chest radiography were correlated. RESULTS: Approximately 8% of patients with radiographic findings of no acute disease, pleural effusion, and linear atelectasis had high-probability ventilation-perfusion scans. Pulmonary edema and parenchymal consolidation categories had fewer high-probability studies (3% and 1%, respectively; P < .01). The chance of obtaining a nondiagnostic result was similar for the first three categories (12%) but was more likely for pleural effusion and parenchymal consolidation (36% and 82%, respectively; P < .01). CONCLUSION: The results of ventilation-perfusion scanning are not useful with focal radiographic consolidation. It may be appropriate to proceed directly to pulmonary angiography in many of these patients.

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