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Case 74¹

¹ From the Department of Radiology, The Churchill Hospital, Oxford, England. Received September 3, 2002; revision requested October 31; revision received March 19, 2003; accepted April 14. Address correspondence to P.M.P., Department of Neuroradiology, The Radcliffe Infirmary, Woodstock Rd, Oxford OX2 6HE, England (e-mail: pretoriuspieter@hotmail.com).

Index terms: Diagnosis Please

	HISTORY

TOP HISTORY

 
A 61-year-old man with hypogamaglobulinemia presented with recent onset of shortness of breath and pleuritic chest pain. He was slightly cyanotic. Results of an examination of the chest and cardiovascular system were unremarkable. There was no history of cardiac disease. A chest radiograph showed a few small areas of peripheral airspace opacity. Perfusion lung scintigraphy was performed to assist in the evaluation of pulmonary embolism (Fig 1) after injection of technetium 99m–macroaggregated albumin (^99mTc-MAA) into a right arm vein. Given the findings of this examination, contrast material–enhanced computed tomography (CT) of the chest was performed on the same day (Fig 2). A 100-mL dose of iopamidol 300 was injected into a right arm vein at a rate of 4 mL/sec, and image acquisition commenced 20 seconds after the start of the injection. Another episode of pleuritic chest pain prompted another perfusion examination 19 days later. This time, ^99mTc-MAA was injected into a left arm vein (Fig 3).

View larger version (190K): [in this window] [in a new window] [Download PPT slide]   Figure 1. Anterior and posterior views of the first perfusion lung scintigram.

View larger version (97K): [in this window] [in a new window] [Download PPT slide]   Figure 2a. Chest CT scans acquired 20 seconds after the start of intravenous injection of contrast material.

View larger version (90K): [in this window] [in a new window] [Download PPT slide]   Figure 2b. Chest CT scans acquired 20 seconds after the start of intravenous injection of contrast material.

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 2c. Chest CT scans acquired 20 seconds after the start of intravenous injection of contrast material.

View larger version (86K): [in this window] [in a new window] [Download PPT slide]   Figure 3. Anterior and posterior views of a perfusion lung scintigram obtained 19 days after the first examination.

	FOOTNOTES

 
E-mail the most likely diagnosis to dxplease@rsna.org (use only for submission of diagnosis). Include case number, your name (as you would want it to appear in the journal), address, phone and fax numbers. Only one case, one name, and one diagnosis per e-mail submission. Multiple diagnoses, multiple submissions, submissions without a case number will not be considered. Deadline: Midnight U.S. Central Time, July 15, 2004. Answer will appear in the September issue. Authors wishing to submit cases for Diagnosis Please should first write to the Editor to obtain approval for the case and further information.

This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pretorius, P. M. Articles by Gleeson, F. V. Search for Related Content PubMed Articles by Pretorius, P. M. Articles by Gleeson, F. V.