CT pulmonary angiography as a part of a diagnostic algorithm in a patient with a recurrent pulmonary embolism and a chronic renal failure

Summary

Introduction: The aim of our case report is to demonstrate overuse and potentially risky use of pulmonary CT angiography in patient with a recurrent pulmonary embolism and a chronic renal failure.

Material and methods: 56-y-old patient was sent to our department by his general practitioner to an emergency follow-up lung perfusion scintigraphy due to an exertional dyspnea which appeared after termination of anticoagulant therapy in April 2010. He had a bilateral pulmonary embolism on March 2008 with a massive recurrence in September 2008 also after termination of anticoagulation in his history. Recent pulmonary scintigraphy demonstrated again bilateral segmental to lobar embolism and the patient was sent to hospitalization to the internal department.

Results: Emergency CT pulmonary angiography was required immediately after the admission. It demonstrated emboli with a partial flow around in the lobar arteries for the upper and the lower lobe of the right lung and for the lower lobe of the left lung in accordance with pulmonary scintigraphy. The patient has a chronic hydronephrosis with afunction of the right kidney with a chronic renal failure in his history. Ultrasonography did not detect any thrombosis in the lower extremities veins, hematological investigation revealed only slight factor IX deficit, echocardiography was normal, oncological screening was negative. Patient was discharged after LMWH treatment, follow-up study was not required.

Conclusion: CT pulmonary angiography did not bring any new information comparing to lung perfusion scintigraphy. Moreover, the patient had a functionally solitary kidney with a chronic renal insufficiency. Therefore, we believe that the CT pulmonary angiography was redundant and potentially dangerous for the patient. We also believe, that the follow-up study after pulmonary embolism is important from the point of view of possible progression to CTEPH and should be required.

Keywords:

pulmonary embolism (PE) – CT pulmonary angiography (CTPA) – scintigraphy – chronic renal insuficiency