Correct!
5. Ventilation – perfusion scintigraphy

Among the choices listed, ventilation – perfusion scintigraphy (V/Q scan) is the best choice because the patient’s worsening shortness of breath and elevated pulmonary arterial pressure raise the possibility of thromboembolic disease, although this consideration is but one of a number of possibilities for the patient’s condition. Surgical lung biopsy is as yet premature, and could engender a higher-than-average risk for complications given the pulmonary hypertension. Thoracic MRI would probably add little to what is known already from the unenhanced thoracic CT, and certainly would not yield additional information regarding the pulmonary abnormalities. 68Ga-Dotatate scanning is useful for the assessment of neuroendocrine malignancies, which is not as yet a primary consideration for this patient’s condition.

The patient underwent ventilation-perfusion scanning (Figure 3).

Figure 3. Ventilation and perfusion scintigraphy (posterior views).

Which of the following represents the most accurate assessmentof the ventilation-perfusion scan findings? (Click on the correct answer to proceed to the sixth of twelve pages)

1. Ventilation – perfusion scintigraphy shows normal findings
2. Ventilation – perfusion scintigraphy shows findings suggesting a low probability of thromboembolic disease
3. Ventilation – perfusion scintigraphy shows findings suggesting an intermediate probability of thromboembolic disease
4. Ventilation – perfusion scintigraphy shows findings suggesting a high probability of thromboembolic disease
5. Ventilation – perfusion scintigraphy shows pulmonary-to-systemic arterial shunting

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