Lung scintigraphy in the diagnosis and follow-up of pulmonary thromboembolism in children with nephrotic syndrome

Thromboembolic phenomenon and pulmonary embolism is quite frequent in children with nephrotic syndrome (NS). The incidence of pulmonary thromboembolism in children with NS is as common as in adults, and severity is also reported to be relatively high. The mortality rate in NS with thromboembolic complications may be significantly increased if not diagnosed and treated well in time. For establishing the diagnosis of pulmonary embolism, although the combined use of magnetic resonance venography and CT angiography has been proposed, V/Q scan is still the best modality. We performed serial lung perfusion scans in two young patients with NS who developed sudden onset tachypnea during their stay in the hospital. Initial lung perfusion scans showing marked perfusion defects and normal chest X-rays indicated a high probability for pulmonary embolism. The patients were treated with streptokinase, and the study was repeated. Marked improvement was seen in lung perfusion, thereby highlighting the importance of lung perfusion scan in the follow-up of such patients. (c) 2005 Elsevier Inc. All rights reserved.