A pulmonary angiogram is a medical imaging test that visualizes blood vessels within the lungs. This X-ray procedure uses a contrast dye to highlight the pulmonary arteries and veins, allowing healthcare providers to observe blood flow and identify abnormalities. It provides detailed images of the lung’s vascular network.
Reasons for a Pulmonary Angiogram
Healthcare providers typically recommend a pulmonary angiogram to investigate specific conditions affecting the lung’s blood vessels. The most common reason for this procedure is to diagnose a pulmonary embolism (PE), which is a blood clot that has traveled to the lungs and is blocking blood flow.
Beyond blood clots, a pulmonary angiogram can also help identify other vascular issues. These include pulmonary artery malformations, where arteries and veins are abnormally connected, or aneurysms, which are bulges in the blood vessel walls. It can also assess pulmonary hypertension, a condition involving high blood pressure in the arteries of the lungs, or evaluate blood flow before or after lung surgery.
The Angiogram Procedure
The patient lies on their back on an X-ray table, and intravenous (IV) lines are placed, often in the arm or hand, to administer medications and fluids. Electrodes are attached to the chest to monitor heart rate, blood pressure, and breathing throughout the procedure. A mild sedative may be given to help the patient relax, though they typically remain awake.
After preparing the insertion site, usually in the groin or sometimes the arm, the area is cleaned and numbed with a local anesthetic. A thin, flexible tube called a catheter is then inserted into a vein and guided through the body’s vascular system. This catheter is advanced, with real-time X-ray guidance (fluoroscopy), through the right side of the heart and into the pulmonary artery, which leads to the lungs.
Once the catheter is correctly positioned, a contrast dye is injected through it. This dye makes the blood vessels visible on the X-ray images. The injection of the dye may cause a temporary warm or flushed sensation. Multiple X-ray images are captured as the dye moves through the vessels, typically lasting less than an hour.
Preparing for and Recovering from the Procedure
Patients are usually advised to avoid eating or drinking for several hours before the test, often 6 to 8 hours. It is important to inform the medical team about any allergies, especially to contrast dye or iodine, and to discuss all current medications, particularly blood thinners, as adjustments may be necessary. Patients may also be asked to remove jewelry and wear a hospital gown.
Following the angiogram, patients are moved to a recovery area for observation. The catheter insertion site, typically in the groin, will be checked for bleeding, and pressure may be applied to prevent hematoma formation. Patients are usually advised to lie flat and keep the limb straight for a few hours after the procedure to promote healing at the access site.
Most individuals can return home the same day, though an overnight stay may be needed in some cases. It is important to arrange for someone to drive home after the procedure. At home, patients should drink plenty of fluids to help flush the contrast dye from their system. Strenuous physical activity, hot baths, and prolonged soaking of the insertion site should be avoided for a few days. The puncture site should be regularly checked for any signs of complications like excessive bleeding, swelling, or infection.
Potential Risks
A pulmonary angiogram carries some potential risks. Common, less serious effects include bruising, soreness, or swelling at the catheter insertion site. These usually resolve within a few days.
More significant, though rare, risks can occur. These include an allergic reaction to the contrast dye, which can range from mild to severe. There is also a small chance of kidney problems, particularly for individuals with pre-existing kidney conditions, due to the dye. Other potential complications include infection at the insertion site, vascular injury from the catheter, or abnormal heart rhythms. Although uncommon, a blood clot could travel to the lungs, or in very rare instances, a stroke or heart attack could occur.
Understanding the Results
The images are carefully reviewed by a radiologist or cardiologist. This specialist interprets the findings, looking for any blockages, narrowing, or other abnormalities in the pulmonary blood vessels. The results are then typically shared with the referring healthcare provider.
The timeframe for receiving results can vary, but they are often available within a short period, sometimes immediately if the situation requires urgent attention. A clear result indicates normal blood flow, while an abnormal result might show a pulmonary embolism or other vascular issues. Based on the findings, the healthcare provider will discuss the diagnosis and outline the next steps, which could include further monitoring, medication, or other treatment options.