Does A Normal Perfusion Only Lung Scan With Normal Chest Xray Rule Out Pulmonary Embolism?

Posted on Wed, 20 May 2020

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 20 May 2020 Answered on

1 day ago Last reviewed on

Question : Does a normal perfusion only lung scan with normal chest xray rule out pulmonary embolism?Ventilation part wasn't done due to the corona virus in N.Y and can't do cat scan with because of allergic reaction.Have a dvt in right upper arm since Dec 14th was only on blood thinners for 3 weeks due to side effects doc tried others couldn't tolerate.Its now may 20th been having chest pain ,shortness of breath ,and upper back pain since March .Last d dimer was normal

Answered by Dr. Dr. Jolanda (40 minutes later)

Brief Answer:
Blood thinners should be restarted and pulmonary embolism not much possible

Detailed Answer:
Hello and welcome in Ask the Doctor

I can understand your concern

Usually in such cases like yours when we have a normal perfusion lung scan and also a normal D dimer we can say that pulmonary embolism is excluded. You should also know that perfusion scan is also first choice for small lung vessels and with cat scan they might not be evaluated.

The ventilation scan is not specific for pulmonary embolism but for airways diseases. We do the chest X ray not to diagnose embolism but to exclude other lung problems also such as pneumonia , pleural liquid etc. In your case they are already excluded.

So in conclusion I strongly recommend you to continue blood thinner for at least 3-6 months. I don't know the contraindications in your case however if you don't tolerate one class of them ,there are other classes you can use (Xarelto for example)

In conclusion in my opinion considering the above facts is pulmonary embolism has not much possibilities nevertheless blood thinners should be restarted as soon as possible.

Please discuss with your doctor for the above

Hope to have been helpful

Regards

Dr.Jolanda

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Jolanda (41 minutes later)

I have discussed this with my doc but he said with a normal lung perfusion and normal xray as well as d dimer he cant justify treating for a pe..
With the information I provided tho your professional opinion is that it is very unlikely to be a PE causing these symptons.

Answered by Dr. Dr. Jolanda (17 minutes later)

Brief Answer:
You don't have pe now

Detailed Answer:
Hi again

No you don't need to be treated for pulmonary embolism because regarding the examination the probability to have it now is low.
You should absolutely be treated for dvt now which directly protects you against empolism.The type of blood thinner depends on your actual organism status ( hemorrhage, gastric ulcer, low platelet count these are contraindications for blood thinner use)

So in conclusion you don't need treatment for pe because you don't have it.

Regards

Dr.Jolanda

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Jolanda (1 hour later)

My primary doc told me a dvt at 5 months would be calcified and adhered to the vein wall and at this point wouldn't break off forming a PE..Where as a fresh dvt up to 4 weeks has a high probability to form a PE.
So your expert opinion is that my present symptoms aren't related to a PE.

Answered by Dr. Dr. Jolanda (37 minutes later)

Brief Answer:
Not they're not related to PE

Detailed Answer:
Hi again,

According to D dimer values and especially perfusion scan results, chances for you to have actual pulmonary embolism are low.

Just continue the blood thinners for 3-6 months.

Regards

Dr.Jolanda

Above answer was peer-reviewed by : Dr. Arnab Banerjee