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Pulmonary embolism in pregnancy — ABIM Board MCQ

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HardPulmonary/Critical CarePulmonary embolism in pregnancyABIM Board

A 30-year-old woman at 24 weeks’ gestation has sudden pleuritic pain and dyspnea. Compression ultrasonography shows no DVT, chest radiograph is normal and pulmonary embolism remains clinically likely. Which chest imaging test is preferred next?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Obtain ventilation-perfusion lung scintigraphy as the next chest study

The best answer is “Obtain ventilation-perfusion lung scintigraphy as the next chest study”. After negative leg ultrasonography in a pregnant patient who still requires chest imaging, the chest radiograph guides modality choice. A normal radiograph favors ventilation-perfusion scintigraphy because it is likely to be diagnostic with lower maternal breast radiation; an abnormal radiograph favors CT pulmonary angiography. Neither D-dimer repetition nor invasive angiography is the next test here.

Reference: ATS/STR Guideline: Suspected Pulmonary Embolism in Pregnancy: https://pubmed.ncbi.nlm.nih.gov/22086989/