A 71 yo male with CRI and a creatinine of 4 presented with dehydration and a wide A-a gradient. CXR was normal. His creatinine bumped on admission; as such, we did not want to do a CT scan. So, we obtained a V/Q scan.
Quick question: if a patient has an indeterminent V/Q scan because of a mismatched defect in the RML medial segment, can a PE be effectively ruled out with an isolated injection of the corresponding vessel supplying the RML?
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You mean a directed angio, I presume? I don't think that a negative directed angio rules out a PE. A positive directed angio, however, would rule in PE, and you'd have your indication for treatment.
Another option, in addition to checking dopplers, would be MR angiography. If your radiologists see those on occasion and the patient can hold his/her breath you may not need to deal with the issue of contrast and renal failure.
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