What is the role of angiography in the diagnosis of cor pulmonale?

Updated: Dec 15, 2017
  • Author: Derek Leong, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Pulmonary thromboembolism has a wide range of clinical presentations—from massive embolism with acute and severe hemodynamic instability to multiple chronic peripheral embolisms—that may present with cor pulmonale. [16]

Pulmonary angiography was historically the gold standard for diagnosing acute pulmonary embolism. The injection of a radiocontrast dye under fluoroscopy allows for direct imaging of the pulmonary vasculature. This has been largely replaced by computed tomography pulmonary angiography (CTPA), which involves the injection of an iodinated contrast while obtaining CT scanning of the chest. CTPA is both sensitive and specific and only requires intravenous (IV) access; as a result, it is the first-line diagnostic imaging modality to diagnose a suspected pulmonary embolism.

Ventilation/perfusion (V/Q) scanning is often performed in cases in which the iodinated contrast agent used in CTPA is contraindicated (eg, pregnancy, renal insufficiency, contrast allergy). By comparing both ventilation and perfusion using a radionucleotide, perfusion deficits within areas of normal ventilation are highly suspicious of a pulmonary embolism. V/Q scanning is the test of choice in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH), as it is more sensitive than CTPA. [17]

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