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Pulmonary Angiography, Ventilation Lung Scanning, and Venography for Clinically Suspected Pulmonary Embolism with Abnormal Perfusion Lung Scan

RUSSELL D. HULL, M.B., B.S., M.SC.; JACK HIRSH, M.D.; CEDRIC J. CARTER, M.B., B.S.; RICHARD M. JAY, M.D.; PEARL E. DODD; PAUL A. OCKELFORD, M.B., B.S.; GEOFFREY COATES, M.B., B.S., M.SC.; GERALD J. GILL, M.D.; A. GRAHAM TURPIE, M.B., Ch.B.; DANIEL J. DOYLE, M.B., B.S.; HARRY R. BULLER, M.D., Ph.D.; and GARY E. RASKOB, B.SC.
[+] Article and Author Information

Grant support: Ontario and Canadian Heart Foundation.

▸Requests for reprints should be addressed to Russell D. Hull, M.B.; Department of Medicine, Health Sciences Centre, Room 3W10; McMaster University, 1200 Main Street West; Hamilton, Ontario, Canada L8N 3Z5.


Hamilton, Ontario, Canada


Ann Intern Med. 1983;98(6):891-899. doi:10.7326/0003-4819-98-6-891
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Inherent contradictions in current diagnostic recommendations for pulmonary embolism have created considerable confusion and controversy. To resolve these contradictions, we did a prospective study of ventilation-perfusion scanning, pulmonary angiography, and venography in consecutive patients with clinically suspected pulmonary embolism and abnormal perfusion scans. Ventilation scanning increased the probability of pulmonary embolism in patients with large perfusion defects and ventilation mismatch, but a ventilation-perfusion match was not helpful in ruling out pulmonary embolism. Small perfusion defects with mismatch had neither sufficiently high nor low probability to be of diagnostic value. The observed frequency of proximal vein thrombosis (19% to 51%) and its association with the range of ventilation-perfusion defects have important implications for management of pulmonary embolism. Pulmonary angiography is required in combination with venography in most patients with perfusion abnormalities because the probability of pulmonary embolism is neither sufficiently high nor low to confirm or exclude pulmonary embolism.

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