Angiography in Pulmonary Embolism

Abstract

Angiographic technique, though used as far back as the early 1930s for examination of the pulmonary artery (Carvalho and Moniz 1933), has been used only in the past two decades for diagnosis of pulmonary emboli. The first angiographic studies to deal with pulmonary embolism in man were reported in patients who were examined for primary pulmonary hypertension. Large series of patients studied by angiography because of suspected embolic disease were reported in the early 1960s, when selective pulmonary angiography was used in the diagnosis of acute pulmonary embolism (Williams and Wilcox 1963; Sasahara et al. 1964). Pulmonary angiography is now the most exact method of determining whether emboli are present or not (Dalen et al. 1971). Neither clinical symptoms nor laboratory techniques nor isotope lung scans are reliable enough to permit the diagnosis of pulmonary embolism with such certainty that active procedures such as anticoagulation, inferior vena cava ligation, and nonsurgical or surgical thrombectomy would be indicated (Green-field 1976). In addition to the detection of pulmonary embolism by angiography, hemodynamic studies performed at the same time permit evaluation of the severity of pulmonary vascular obstruction by the emboli. Correlation of angiographic findings with hemodynamic and clinical findings in acute pulmonary embolism has greatly enhanced the understanding of the pathophysiology of the disease.