Abstract:
:A significant right-to-left shunt at the atrial level was diagnosed by radionuclide angiocardiographic examination in a patient with hypoxemia whose perfusion scan showed no pulmonary uptake. The shunt occurred through a patent foramen ovale due to increased right ventricular afterload, subsequently confirmed at autopsy. It is concluded that radionuclide angiocardiography with technetium 99m macroaggregated albumin (99mTc MAA), followed immediately by a perfusion lung scan, may have a place in the evaluation of patients with refractory hypoxemia, since pulmonary embolism and/or right-to-left shunting are two of several causes of hypoxemia in the absence of congenital heart disease. A review of the literature on different pathophysiologic factors is presented and some therapeutic implications, specifically the adverse effect of PEEP in such situations, are discussed.
journal_name
Chestjournal_title
Chestauthors
Salimi Z,Thomasson J,Vas W,Salimi Adoi
10.1378/chest.88.5.784subject
Has Abstractpub_date
1985-11-01 00:00:00pages
784-6issue
5eissn
0012-3692issn
1931-3543pii
S0012-3692(16)62212-2journal_volume
88pub_type
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