Multiple matched ventilation-perfusion defects in illicit drug use

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A 21-YEAR-OLD BLACK WOMAN presented to the emergency room with a history of acute onset of shortness of breath and associated chest pain. The patient had been snorting heroin intranasally and smoking freebased cocaine 30 minutes before the onset of dyspnea. The dyspnea continued for 30 to 36 hours, prompting her to seek medical assistance at the emergency room. The patient gave no history of asthma or significant smoking of tobacco and denied any drug use. Physical examination showed a young black female in mild respiratory distress. There was no calf swelling or tenderness. A posterioranterior and lateral chest radiograph (Fig 1) demonstrated normal heart size and clear lung fields bilaterally. Although the patient denied use of oral contraceptives, pulmonary embolism was considered as a potential cause of these findings. A ventilation-perfusion lung imaging study was performed using aerosolized inhalation of 1.1 mCi of technetium-99m (99mTc) diethylenetriaminepentaacetic acid (DTPA) with images obtained from the anterior, posterior, and bilateral posterior oblique projections using a general purpose collimator. The perfusion study followed using an intravenous injection of 3.5 mCi of 99mTc microaggregated albumin (MAA), with images obtained in the same projections. The images demonstrated multiple, bilateral, matched, nonsegmental ventilation and perfu-