Scintigraphy Leading to the Misdiagnosis of Chronic Thromboembolic Disease in a Patient With Pulmonary Veno-Occlusive Disease

A 43-year-old woman experienced increasing dyspnea over a period of 1 year. She was examined first at an outside hospital. Diagnostic workup revealed an elevated precapillary mean pulmonary arterial pressure of u003e44 mm Hg. Left ventricular function was nearly normal (cardiac index, 2.1 L/min·m2; pulmonary wedge pressure, 15 mm Hg). Computed tomography of the lung demonstrated regional ground glass opacities and pleural effusions but no signs of pulmonary embolism. Perfusion and ventilation scintigraphy showed perfusion defects typical for peripheral lung embolism (Figure 1). The diagnosis of chronic thromboembolic pulmonary hypertension was made. There was no correlate in pulmonary angiography …