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.
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
- Pulmonary embolism
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 angiogram.
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 following:
- 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 procedure.
- 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 general).
- 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 shaved.
- Based on your medical condition, your doctor may request other specific preparation.
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.