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Selective pulmonary angiogram revealing significant thrombus (labelled A) causing a central obstruction in the left main pulmonary artery

Pulmonary angiography (or pulmonary arteriography,conventional pulmonary angiography, selective pulmonary angiography) is a medical fluoroscopic procedure used to visualize the pulmonary arteries and much less frequently, the pulmonary veins. It is a minimally invasive procedure performed most frequently by an interventional radiologist or interventional cardiologist to visualise the arteries of the lungs.

Uses

Pulmonary angiography is useful as the confirmation test where the non-invasive imaging such as CT pulmonary angiography is inconclusive on determining the presence of pulmonary embolism.^[1] The accuracy of pulmonary angiography may be higher than clinical examination, arterial blood gas results, and ventilation/perfusion scan.^[2] Pulmonary angiography is also used to confirm chronic thromboembolic pulmonary hypertension (CTEPH) and provides a platform for balloon pulmonary angioplasty to treat the disease.^[3]

CT pulmonary angiography has nearly entirely replaced conventional pulmonary angiography in common practice as it is less invasive, faster, safer, and provides most of the same diagnostic information with the added benefit of visualizing the lung tissue as well as other structures. Nevertheless, it is still used in cases where CT angiography is nondiagnostic.

Procedure

Types of catheters that can be used are pigtail catheters and balloon occlusion catheters. Tip of the catheter is advanced through the inferior vena cava, right atrium, right ventricle, right ventricular outflow tract, pulmonary trunk, and the tip is parked in the left pulmonary artery.^[4]

History

Conventional pulmonary angiography was first performed in 1931 by Portuguese angiography pioneers Lopo de Carvalho, Egas Moniz and colleagues.^[5] Robb and Steinberg described pulmonary angiography by infusion of peripheral radiocontrast.^[6]^[7]

References

^ van Beek EJ, Brouwerst EM, Song B, Stein PD, Oudkerk M (October 2001). "Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary embolism--a critical review". Clinical Radiology. 56 (10): 838–42. doi:10.1053/crad.2001.0778. PMID 11895301.
^ Menzoian JO, Williams LF (April 1979). "Is pulmonary angiography essential for the diagnosis of acute pulmonary embolism?". American Journal of Surgery. 137 (4): 543–8. doi:10.1016/0002-9610(79)90128-4. PMID 426205.
^ Velázquez M, Maneiro N, Lareo A, Albarrán A, Huertas S, Olazábal AP, Delgado JF, Alonso S, Sarnago F, García Tejada J, Arribas F, Escribano P (July 2021). "Selective Segmental Pulmonary Angiography: Anatomical, Technical and Safety Aspects of a Must-Learn Technique in Times of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension". Journal of Clinical Medicine. 10 (15): 3358. doi:10.3390/jcm10153358. PMC 8347158. PMID 34362139.
^ "Pulmonary Angiography Pulmonary Angiography". Archived from the original on 5 June 2022. Retrieved 5 June 2022.
^ Moniz E, Carvalho L, Lima A (1931). "Angiopneumographie". Presse Med. 39: 996–99.
^ Robb GP, Steinberg I (1938). "A practical method of visualization of the chambers of the heart, the pulmonary circulation, and the great blood vessels in man". J Clin Invest. 17 (4): 501–537. doi:10.1172/JCI100977. PMC 434806.
^ Acierno, L.J (1994-02-15). The History of Cardiology. Taylor & Francis. ISBN 9781850703396.