Near fatal pulmonary embolism in a 16-year-old

Acute pulmonary thrombo-embolism (PE) may present with a variety of clinical problems; patients with this condition may range from being asymptomatic to acutely unwell, with sudden death being at the extreme end of the spectrum. This case report of a young man with PE demonstrates the scintigraphic features of massive, near-fatal embolism. On transfer to the Nuclear Medicine Department, the patient's blood pressure was unrecordable, the heart rate was 150/min, there was deep cyanosis despite 100 per cent oxygen and the pupils were fixed and dilated. A limited perfusion scan was obtained using 76 MBq of 99mTc-MAA (Technescan MAA, Mallinckrodt), with an estimated 260 000 MAA particles being injected directly into a peripheral vein. Anterior and posterior images showed perfusion only to a small portion of the left upper lobe. The patient recovered quickly following embolectomy resulting in removal of a large amount of thrombus from both pulmonary arteries. It has been thus demonstrated that the perfusion scan is a rapid and safe method of confirming suspected massive PE prior to surgery. 4 refs., 2 figs