(Angiogram-Pulmonary, Pulmonary Angiography, Pulmonary Arteriogram,
Pulmonary Arteriography, Angiogram of the Lungs)
An angiogram, also called an arteriogram, is an X-ray image of the blood
vessels. It is performed to evaluate various vascular conditions, such
as an aneurysm (ballooning of a blood vessel), stenosis (narrowing of a
blood vessel), or blockages.
A pulmonary angiogram is an angiogram of the blood vessels of the lungs.
A pulmonary angiogram may be used to assess the blood flow to the lungs.
One of the primary indications for the procedure is the diagnosis of a
pulmonary embolus (clot). It may also be used to deliver medication into
the lungs to treat cancer or hemorrhage.
In order to obtain a radiographic (X-ray) image of a blood vessel, an
intravenous (IV) access is necessary so that a contrast dye can be
injected into the body's circulatory system, which includes the
pulmonary (lungs) circulatory system. This contrast dye causes the blood
vessels to be visible on X-ray film. This allows the doctor to see the
size, shape, and many branches of the pulmonary vessels, in particular,
the pulmonary artery that circulates blood to the lungs.
Fluoroscopy is often used during a pulmonary angiogram. Fluoroscopy is
the study of moving body structures, similar to an X-ray "movie." A
continuous X-ray beam is passed through the body part being examined,
and is transmitted to a TV-like monitor so that the body part and its
motion can be seen in detail.
An additional technology that may be used with an angiogram is called
digital subtraction angiography (DSA). DSA still requires a contrast dye
to be injected into the pulmonary circulation. However, with DSA, a
masked image is made prior to the injection of the dye with fluoroscopy.
A computer digitally subtracts (or removes) everything from the image
except that which is injected with the contrast dye, so that the
computer image remaining is one of the pulmonary blood vessels only.
Other related procedures that may be used to diagnose problems of the
chest and respiratory tract include chest X-rays, computed tomography
(CT scan) of the chest, bronchoscopy, bronchography, chest fluoroscopy,
chest ultrasound, lung biopsy, lung scan, mediastinoscopy, positron
emission tomography (PET scan) of the chest, pleural biopsy, and
thoracentesis. Please see these procedures for additional information.
respiratory system is made up of the organs involved in the interchanges
of gases, and consists of the:
The upper respiratory tract includes the:
Ethmoidal air cells
The lower respiratory tract includes the lungs, bronchi, and alveoli.
The lungs take in oxygen, which cells need to live and carry out their
normal functions. The lungs also get rid of carbon dioxide, a waste
product of the body's cells.
The lungs are a pair of cone-shaped organs made up of spongy,
pinkish-gray tissue. They take up most of the space in the chest, or the
thorax (the part of the body between the base of the neck and
The lungs are enveloped in a membrane called the pleura.
The lungs are separated from each other by the mediastinum, an area that
contains the following:
The heart and its large vessels
The right lung has three sections, called lobes. The left lung has two
lobes. When you breathe, the air enters the body through the nose or the
mouth. It then travels down the throat through the larynx (voice box)
and trachea (windpipe) and goes into the lungs through tubes called
One main-stem bronchus leads to the right lung and one to the left lung.
In the lungs, the main-stem bronchi divide into smaller bronchi and then
into even smaller tubes called bronchioles. Bronchioles end in tiny air
sacs called alveoli.
A pulmonary angiogram may be performed to visualize the pulmonary
vascular system, to evaluate for abnormalities, and to determine
pressures within the pulmonary circuit. One of the most common reasons
is to confirm the presence of a pulmonary embolus (clot) in one or more
of the blood vessels in the lungs. A clot may be treated, if present.
Pulmonary angiograms are rarely performed anymore, as CT angiography
(CTA) of the chest has largely replaced this procedure. Pulmonary
angiograms are typically only performed if simultaneous treatment of a
known clot is to be performed.
Abnormalities that may be detected by a pulmonary angiogram include, but
are not limited to, the following:
Arteriovenous malformation. A direct communication of an artery
to a vein
Congenital heart and/or vascular anomalies. Structural defects
present at birth
Foreign body in the blood vessels
Stenosis. Narrowing of a blood vessel wall
A pulmonary angiogram may be used to evaluate the blood vessels and
blood flow in the lungs before and/or after surgery or other procedures
involving the blood vessels.
There may be other reasons for your doctor to recommend a pulmonary
You may want to ask your doctor about the amount of radiation used
during the procedure and the risks related to your particular situation.
It is a good idea to keep a record of your past history of radiation
exposure, such as previous scans and other types of X-rays, so that you
can inform your doctor. Risks associated with radiation exposure may be
related to the cumulative number of X-ray examinations and/or treatments
over a long period of time.
If you are pregnant or suspect that you may be pregnant, you should
notify your health care provider. Radiation exposure during pregnancy
may lead to birth defects.
There is a risk for allergic reaction to the dye. Patients who are
allergic to or sensitive to medications, contrast dye, or iodine should
notify their doctor. Also, patients with kidney failure or other kidney
problems should notify their doctor.
Because the procedure involves the blood vessels and blood flow of the
lungs and chest, there is a small risk for complications involving these
structures. These complications may include, but are not limited to, the
Hemorrhage due to puncture of a blood vessel
Injury to nerves
Embolus. A clot in the blood vessel
Hematoma. An area of swelling caused by a collection of blood
There may be other risks depending on your specific medical condition.
Be sure to discuss any concerns with your doctor prior to the procedure.
Your doctor will explain the procedure to you and offer you the
opportunity to ask any questions that you might have about the
You will be asked to sign a consent form that gives your
permission to do the test. Read the form carefully and ask
questions if something is not clear.
Notify your doctor if you have ever had a reaction to any
contrast dye, or if you are allergic to iodine.
Notify your doctor if you are sensitive to or are allergic to
any medications, latex, tape, and anesthetic agents (local and
You will need to fast for a certain period of time prior to the
procedure. Your doctor will notify you how long to fast, whether
for a few hours or overnight.
If you are pregnant or suspect that you may be pregnant, you
should notify your doctor.
Notify your doctor of all medications (prescription and
over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders,
or if you are taking any anticoagulant (blood-thinning)
medications, aspirin, or other medications that affect blood
clotting. It maybe necessary for you to stop these medications
prior to the procedure.
Your doctor may request a blood test prior to the procedure to
determine how long it takes your blood to clot. Other blood
tests may be done as well.
You may receive a sedative prior to the procedure to help you
relax. If a sedative is given, you will need someone to drive
you home afterwards.
Depending on the site used for injection of the contrast dye,
the recovery period may last up to 12 to 24 hours. You should be
prepared to spend the night if necessary.
The area around the catheter insertion (groin area) may be
Based on your medical condition, your doctor may request other
A pulmonary angiogram may be performed on an outpatient basis or as part
of your stay in a hospital. Procedures may vary depending on your
condition and your doctor's practices.
Generally, a pulmonary angiogram follows this process:
You will be asked to remove any clothing, jewelry, or other
objects that may interfere with the procedure.
If asked to remove clothing, you will be given a gown to wear.
You will be asked to empty your bladder prior to the start of
An intravenous (IV) line will be inserted in your arm or hand.
You will be placed in a supine (on your back) position on the
You will be connected to an EKG monitor that records the
electrical activity of the heart and monitors the heart during
the procedure using small, adhesive electrodes. Your vital signs
(heart rate, blood pressure, breathing rate, and oxygenation
level) will be monitored during the procedure.
The radiologist will check your pulses below the injection site
for the contrast dye and mark them with a marker so that the
circulation to the limb below the site can be checked after the
A special catheter will be inserted either in your arm or in the
groin area after the skin is cleansed and a local anesthetic is
The catheter will be advanced through the vein to the right side
of the heart. A special type of X-ray, called fluoroscopy,
(displayed on a television monitor), may be used to assist in
advancing the catheter through the chambers of the heart to the
pulmonary artery or one of its branches.
An injection of contrast dye will be given. You may feel some
effects when the dye is injected into the IV line. These effects
include a flushing sensation, a salty or metallic taste in the
mouth, a brief headache, or nausea and/or vomiting. These
effects usually last for a few moments.
You should notify the radiologist if you feel any breathing
difficulties, sweating, numbness, or heart palpitations.
After the contrast dye is injected, a series of rapid sequential
X-ray images will be made.
Depending on the specific study being done, there may be one or
more additional injections of contrast dye.
Once sufficient information has been obtained, the IV catheter
will be removed and pressure will be applied over the area to
keep the blood vessel from bleeding.
After the IV site stops bleeding, a dressing will be applied to
the site. A small sandbag may be placed over the site for a
period of time to prevent further bleeding or the formation of a
hematoma at the site.
After the procedure, you will be taken to the recovery room for
observation. The circulation and sensation of the limb where the
injection catheter was inserted will be monitored. A nurse will monitor
your vital signs and the injection site while you are in the recovery
You will remain flat in bed in a recovery room for a short time (1 to 2
hours) after the procedure. If the groin or arm site was used, the leg
or arm on the side of the injection site will be kept straight while you
are in recovery.
You may be given pain medication for pain or discomfort related to the
injection site or having to lie flat and still for a prolonged period.
You will be encouraged to drink water and other fluids to help flush the
contrast dye from your body.
You may resume your usual diet after the procedure, unless your doctor
When you have completed the recovery period, you may be returned to your
hospital room or discharged to your home. If this procedure was
performed on an outpatient basis, you should plan to have another person
drive you home.
Once at home, you should monitor the injection site for bleeding,
unusual pain, swelling, and abnormal discoloration or temperature change
at or near the injection site. A small bruise is normal, as is an
occasional drop of blood at the site. If you notice a constant or large
amount of blood at the site that cannot be contained with a small
dressing, notify your doctor.
If the groin or arm was used, you should monitor the leg or arm for
changes in temperature or color, pain, numbness, tingling, or loss of
function of the limb.
Drink plenty of fluids to prevent dehydration and to help pass the
You may be advised not to do any strenuous activities or take a hot bath
or shower for a period of time after the procedure.
Notify your doctor to report any of the following:
Fever and/or chills
Increased pain, redness, swelling, or bleeding or other drainage
from the groin injection site
Coolness, numbness and/or tingling, or other changes in the
Your doctor may give you additional or alternate instructions after the
procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was
not designed to diagnose or treat a health problem or disease, or
replace the professional medical advice you receive from your physician.
Please consult your physician with any questions or concerns you may
have regarding your condition.
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