Lowman, Robert M.; Reardon, John; Hipona, Florencio A.; Stern, Harold; Toole, Allan L.
May 1967
Angiology;May1967, Vol. 18 Issue 5, p291
Academic Journal
An aggressive approach is urged in the utilization of pulmonary angiography for the accurate diagnosis of pulmonary embolism. A constant awareness of its frequency, a high suspicion and the recognition of the manifestations of the disease in plain chest roentgenograms are essential. A simplified technique is described which can be readily employed in the diagnosis of this entity. The major angiographic findings in making a diagnosis of pulmonary embolism are anatomic and pathophysiologic alterations. The anatomic changes in the pulmonary arteries are: obstruction, intraluminal filling defects, vessel wall defects, and vessel caliber changes. The pathophysiologic manifestations in the pulmonary-circulation are: stagnation or retarded flow, diminished flow, and avascular areas. Additional findings are seen in the heart by the technique described: intracardiac thrombi, dilatation of the right heart, tricuspid insufficiency, and dilatation of the azygos vein and superior vena cava. Furthermore, pulmonary angiography provides a method for the evaluation of the fate of pulmonary emboli and the possible role played by associated left-heart disease. Whether fibrinolytic mechanisms in the lysis of pulmonary emboli are altered by associated left-heart disease remains a problem. More experience and the refinements of new diagnostic techniques may hopefully offer clues to the diagnosis of those cases which are often misdiagnosed. The diagnosis of peripheral embolism may become a reality by direct magnification pulmonary arteriography.


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