Practice Rational imaging

Investigating suspected pulmonary embolism in pregnancy

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39071.617257.80 (Published 22 February 2007) Cite this as: BMJ 2007;334:418
  1. Andrew Frederick Scarsbrook, consultant radiologist and nuclear medicine physician1,
  2. Fergus Vincent Gleeson, consultant thoracic radiologist2
  1. 1Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF
  2. 2Radiology Department, Churchill Hospital, Oxford Radcliffe Hospitals NHS Trust, Headington, Oxford OX3 7LJ
  1. Correspondence to: F Gleeson fergus.gleeson{at}clinical-medicine.oxford.ac.uk
  • Accepted 12 December 2006

A woman in her early 30s presented at 25 weeks' gestation with shortness of breath and chest pain. Clinical examination was unremarkable. The patient was referred for imaging to exclude suspected pulmonary embolism, as this potentially fatal disorder increases in incidence during pregnancy and is a leading cause of maternal mortality. Physiological changes in pregnancy often cause symptoms that mimic pulmonary embolic disease, such as chest pain and shortness of breath. Objective symptom scoring for assessing the pre-test probability is therefore less reliable in pregnancy and is used only rarely.

Learning points

  • Physiological changes during pregnancy can mimic pulmonary embolism, making clinical diagnosis unreliable

  • Imaging is essential to avoid inappropriate treatment and can be performed without exposing the fetus to any specific risks

  • A chest x ray should always be performed to exclude other causes

  • Half dose perfusion scintigraphy can be used in most patients

  • Computed tomographic pulmonary angiography should be used only in patients with lung disease such as asthma—which makes scintigraphy less likely to be diagnostic—or an abnormal chest x ray, because it exposes maternal breast tissue to high doses of radiation

What test do I order?

Venous thromboembolism is an important diagnosis to confirm …

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