Elderly Patients With no Prior Cardiopulmonary Disease Show Ventilation/Perfusion Lung Scan Characteristics That Are Sensitive and Specific for Pulmonary Embolism.

The purpose of the present investigation was to test the hypothesis that stratification according to age, in addition to stratification according to the presence or absence of prior CPD, in elderly patients may show criteria on V/Q lung scans that have a higher sensitivity for acute PE than the entire population, while maintaining a high specificity and high PPV. Data from the PIOPED were evaluated among 1,050 patients with suspected acute PE in whom the diagnosis was made or excluded by pulmonary angiography. Age groups were at or above 70 years of age (n equals 259), 40-69 years of age (n equals 585) and 18-39 years of age (n equals 206). Patients were stratified according to the presence or absence of prior CPD. Lung scans were evaluated on the basis of the cumulative number of mismatched vascular perfusion defects (large or moderate size mismatched segmental perfusion defects). Among patients at or above 70 years of age who had no prior CPD, greater than or equal to 2 matched vascular perfusion defects showed a sensitivity of 23 of 31 (74%), a specificity of 29 of 29 (100%), and a PPV of 23 of 23 (100%). Stratification according to both age and CPD was particularly useful for the evaluation of V/Q lung scans in patients at or above 70 years of age with no prior CPD, although only 23% of patients at or above 70 years of age had no prior CPD.