Type of test X-ray with contrast dye
Normal findings
Normal pulmonary vasculature
Test explanation and related physiology
Through an injection of a radiographic contrast material into the pulmonary arteries, pulmonary angiography permits visualization of the pulmonary vasculature. Angiography is used to detect pulmonary embolism when the lung scan yields inconclusive results. This study has mostly been replaced by CT of the chest.
Bronchial angiography can be done to identify bleeding sites in the lungs. For this procedure, catheters are placed transarterially into the orifice of bronchial arteries. Radiopaque material is then injected, and the arteries are visualized. If a bleeding site is identified, the site can be injected with a sclerosing agent to prevent further bleeding.
Contraindications
• Patients with allergies to iodinated dye
• Patients who are pregnant, unless benefits outweigh risks
• Patients with bleeding disorders
Potential complications
• Allergic reaction to iodinated dye
• Hypoglycemia or acidosis may occur in patients who are taking metformin and receive iodine dye.
• Cardiac arrhythmia: Premature ventricular contractions during right-sided heart catheterization may lead to ventricular tachycardia and ventricular fibrillation.
Procedure and patient care
Before
* Explain the procedure to the patient. See p. xviii for radiation exposure and risks.
• Ensure that written and informed consent for this procedure is obtained. Inform the patient that a warm flush will be felt when the dye is injected.
• Check the patient for allergies to iodinated dyes.
• Determine whether the patient has ventricular arrhythmias.
• Keep the patient NPO after midnight on the day of the test.
• Administer preprocedural medications as ordered. Atropine may be given to decrease secretions. Meperidine may be used for sedation and relaxation.
During
• Note the following procedural steps:
1. The patient is placed on an x-ray table in the supine position.
2. A catheter is placed into the femoral vein and passed into the inferior vena cava.
3. With fluoroscopic visualization, the catheter is advanced into the main pulmonary artery, where the dye is injected.
4. X-ray images of the chest are immediately taken in timed sequence. This allows all vessels visualized by the injection to be photographed. If filling defects are seen in the contrast-filled vessels, pulmonary emboli are present.
5. If bronchial angiography is performed, the femoral artery is cannulated instead of the vein.
• Note that this test is performed by a physician in approximately 1 hour.
* During injection of dye, inform the patient that he or she will feel a burning sensation and flush throughout the body.
After
• Observe the catheter insertion site for inflammation, hemorrhage, and hematoma.
• Assess the patient’s vital signs for evidence of bleeding.
• Apply cold compresses to the puncture site if needed to reduce swelling or discomfort.
Abnormal findings
- Pulmonary embolism
- Congenital and acquired lesions of the pulmonary vessels (e.g., pulmonary hypertension)
- Tumor
