False Positive Perfusion/Ventilation SPECT Study for Pulmonary Embolism in a Patient with Fontan Circulation/Fontan Dolasimli Bir Hastada Pulmoner Emboli icin Yanlis Pozitif Perfuzyon/Ventilasyon SPECT incelemesi

• Published in: Molecular imaging and radionuclide therapy 2017-10, Vol.26 (3), p.131
• Main Author: Panagiotidis, Emmanouil
• Format: Article
• Language: English
• Subjects: Care and treatment; CAT scans; Congenital heart defects; Diagnosis; Pulmonary embolism; Risk factors; Thromboembolism
• ISSN: 2146-1414
• DOI: 10.4274/mirt.70883

Fontan circulation is the consequence of an operation that results in the flow of systemic venous blood to the lungs without passing through a ventricle. An 18-year old man with a history of congenital heart disease surgically treated with Fontan circulation, presented with pleuritic chest pain and a raised D-dimer level. Perfusion/ventilation SPECT was performed to exclude the possibility of pulmonary embolism (PE) that showed unilateral reduced perfusion of the left lung with a mismatched right upper lobe defect, suspicious of PE. However, subsequent computed tomography pulmonary angiogram and clinical follow-up excluded the possibility of PE, emphasizing the need for knowledge of potential pitfalls to avoid false interpretations. Given the fact that adult congenital heart disease population is growing, with the majority having single ventricle/Fontan circulation and being at risk for thromboembolic disease, knowledge of the perfusion pattern pitfalls is important to avoid false interpretation and preventing the misdiagnosis of PE in patients with Fontan physiology. Keywords: Fontan circulation, perfusion/ventilation, single-photon emission computed tomography, pulmonary embolism, computed tomography pulmonary angiogram Fontan dolasim sistemik venoz kanin ventrikulden gecmeden akcigere ulasmasina neden olan cerrahi girisime baglidir. Konjenital kalp hastaligi nedeniyle Fontan dolasim cerrahisi gecirmis 18 yasinda bir erkek hasta ploretik gogus agrisi ve yuksek D-dimer degeri ile basvurdu. Pulmoner emboliyi (PE) ekarte etmek amaciyla perfuzyon/ventilasyon SPECT yapildi. PE icin supheli olacak sekilde sol akcigerde unilateral perfuzyon azalmasi ve sag ust lobda uyusma defekti saptandi. Ancak bilgisayarli tomografi pulmoner anjiyografi ve klinik takip ile PE olasiligi ekarte edildi. cogunlugu tek ventrikul/Fontan dolasim sahibi ve dolayisiyla tromboembolik hastalik riski altinda olan eriskin konjenital kalp hastalikli populasyonundaki artis goz onunde tutularak, Fontan fizyolojisi olan hastalarda PE yanlis tanisini ve yanlis yorumu engellemek icin perfuzyon patern tuzaklarinin bilinmesi onemlidir. Anahtar kelimeler: Fontan dolasim, perfuzyon/ventilasyon, tek-foton emisyon bilgisayarli tomografisi, pulmoner emboli, bilgisayarli tomografi pulmoner anjiyografi