A doctor inserts a catheter into a vein in your groin or arm, and carefully threads it into the heart’s right upper chamber (atrium), through the right lower chamber (ventricle), and into the main pulmonary artery, which brings blood from the heart to the lungs. The catheter records blood pressures in these areas. A contrast dye is then injected through the catheter to help delineate your pulmonary blood vessels on x-ray images.
Purpose of the Pulmonary Angiography
- To detect a pulmonary embolism (a blood clot in an artery in the lung)—especially after a lung nuclear scan has proven inconclusive
- To evaluate pulmonary blood circulation abnormalities
- To evaluate pulmonary circulation prior to surgery in those with congenital heart disease
- To determine the location of a large pulmonary embolism prior to its surgical removal
- To examine blood vessels in various parts of the body including the brain, kidneys, lungs, heart and abdomen
- To diagnose abnormal connections between veins and arteries in the lung, which are usually present at birth and that narrow the pulmonary vessels
- To diagnose pulmonary hypertension
Who Performs It
- A cardiologist or a radiologist
- Pulmonary angiography is typically performed in a hospital catheterization laboratory. In critically ill patients, the procedure may be done in the intensive care unit.
- People who have a serious bleeding disorder or who are extremely agitated cannot undergo this procedure.
- People who have an allergy to shellfish or iodine may experience an allergic reaction to the contrast dye. Preventive medication may be administered, or a special form of the dye may be used.
- Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
Before the Pulmonary Angiography
- Tell your doctor if you regularly take anticoagulant drugs. You must discontinue them for some time before the test.
- Tell your doctor if you are or could be pregnant.
- Notify your doctor if any history of bleeding problems.
- Inform your doctor if you regularly take nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen), herbs, or nutritional supplements; these agents may need to be discontinued before the test.
- Be sure to tell your doctor if you have a known shellfish or iodine allergy or have ever had an adverse reaction to x-ray contrast dyes.
- Do not eat or drink anything for 4 to 8 hours before the test.
- Immediately before the test, an intravenous (IV) line is inserted into a vein in your arm. You may be given a mild sedative, but you will remain conscious throughout the procedure.
What You Experience
- You lie on your back on a padded table, and ECG leads are applied to monitor your heart rate and rhythm during the procedure.
- The area of catheter insertion (your groin or arm) is cleansed with an antiseptic to help prevent infection and numbed with a local anesthetic. The doctor then makes a small incision and inserts a catheter into the vein; you will feel pressure during insertion, but no other discomfort.
- The doctor threads the catheter through your heart and into your main pulmonary artery, using fluoroscopy to watch its progress on a viewing monitor.
- A contrast dye is administered through the catheter. The dye will circulate through the pulmonary artery and blood vessels in the lung and delineate them on x-rays. You may feel a hot, flushing sensation briefly after injection; some people experience nausea and possibly vomiting.
- The doctor takes several moving and still x-ray pictures (angiograms) of your pulmonary blood vessels for later analysis.
- The procedure takes from 30 minutes to 90 minutes.
Risks and Complications
- Possible complications include abnormal heart rhythms (arrhythmias), blood clot formation, bleeding, blood vessel damage, or infection at the site of catheter insertion.
- Some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, sneezing, vomiting, hives, and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
After the Pulmonary Angiography
- Immediately after the test, you will rest in a recovery room. Your vital signs will be monitored, and you will be observed for signs of complications such as delayed reaction to the contrast dye.
- You are encouraged to drink clear fluids to avoid dehydration and help flush the contrast dye out of your system.
- Most people are able to return home after about 6 to 8 hours, though some may require overnight hospitalization. You will need bed rest for about 12 to 24 hours.
- If you develop swelling or discomfort at the catheter insertion site, apply cold compresses.
- You may experience the urge to cough after this procedure.
- Avoid heavy lifting and do only light activities for a few days after the test.
- The doctor will review the test data for evidence of any pulmonary or circulatory abnormalities.
- This test is usually definitive. Based on the findings, your doctor will then decide on a course of medical or surgical treatment.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media