Choice of imaging modality for the investigation of pulmonary embolism in pregnancy

Author(s): Dr Lynne Armstrong, Dr Andrew Beale

Hospital: United Hospitals Bristol, Great Western Hospital

Reference: RAD Magazine 44, 513, 21-22

Excerpt: 

It is a familiar request on call: A pregnant woman presenting with chest pain and tachycardia – a pulmonary embolism (PE) needs to be excluded. Increasing requests for imaging in this context are unavoidable as PE remains a leading cause of mortality in pregnancy and the post-partum period in the developed world, with an approximate incidence of 2-12 per 100,000 pregnancies and a reported 15% mortality for untreated venous thromboembolic disease in pregnancy.

Scintigraphy is the recommended investigation for nonmassive PE in all patients where the chest radiograph is normal, which is in accordance with guidelines from the American Thoracic Society (ATS)4 and the British Thoracic Society, among others. It is recognised that CT pulmonary angiogram is superior for PE diagnosis in the general population, but there is no specified preferred method in the context of pregnancy, and prospective trials used to validate CTPA in PE diagnosis all excluded pregnant patients.

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