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Definition

Pulmonary angiography is a test to see how blood flows through the lung.

Angiography is an imaging test that uses x-rays and a special dye to see the insides of the arteries. Arteries are blood vessels that carry blood away from the heart.

How the Test is Performed

This test is done at a hospital. You will be asked to lie on an x-ray table.

• Before the test starts, you will be given a mild sedative to help you relax.
• An area of your body, most often the arm or groin, is cleaned and numbed with a local numbing medicine (anesthetic).
• The radiologist inserts a needle or makes a small cut in a vein in the area that has been cleaned. A thin hollow tube called a catheter is inserted.
• The catheter is placed through the vein and carefully moved up into and through the right-sided heart chambers and into the pulmonary artery, which leads to the lungs. The doctor can see live x-ray images of the area on a TV-like monitor, and use them as a guide.
• Once the catheter is in place, dye is injected into the catheter. X-ray images are taken to see how the dye moves through the lungs' arteries. The dye helps detect any blockages to blood flow.

Your pulse, blood pressure, and breathing are checked during the procedure. Electrocardiogram (ECG) leads are taped to your arms and legs to monitor your heart.

After the x-rays are taken, the needle and catheter are removed.

Pressure is applied to the puncture site for 20 to 45 minutes to stop the bleeding. After that time, the area is checked and a tight bandage is applied. You should keep your leg straight for 6 hours after the procedure.

Rarely, medicines are delivered to the lungs if a blood clot has been found during the procedure.

How to Prepare for the Test

You may be asked not to eat or drink anything for 6 to 8 hours before the test.

You will be asked to wear a hospital gown and sign a consent form for the procedure. Remove jewelry from the area being imaged.

Tell your health care provider:

• If you are pregnant
• If you have ever had any allergic reactions to x-ray contrast material, shellfish, or iodine substances
• If you are allergic to any medicines
• Which medicines you are taking (including any herbal preparations)
• If you have ever had any bleeding problems

How the Test will Feel

The x-ray table may feel cold. Ask for a blanket or pillow if you are uncomfortable. You may feel a brief sting when the numbing medicine is given and a brief, sharp, stick as the catheter is inserted.

You may feel some pressure as the catheter moves up into the lungs. The contrast dye can cause a feeling of warmth and flushing. This is normal and usually goes away in a few seconds.

You may have some tenderness and bruising at the site of the injection after the test.

Why the Test is Performed

The test is most often used to detect blood clots (pulmonary embolism) and other blockages in the blood flow in the lung. Most of the time, your provider will have tried other tests to diagnose a blood clot in the lungs.

Pulmonary angiography may also be used to help diagnose:

• AV malformations of the lung
• Congenital (present from birth) narrowing of the pulmonary vessels
• Pulmonary artery aneurysms
• Pulmonary hypertension, high blood pressure in the arteries of the lungs

Normal Results

The x-ray will show normal structures for the age of the person.

What Abnormal Results Mean

Abnormal results may be due to:

• Aneurysms of pulmonary vessels
• Blood clot in the lungs (pulmonary embolism)
• Narrowed blood vessel
• Primary pulmonary hypertension
• Tumor in the lung

Risks

A person may develop an abnormal heart rhythm during this test. The health care team will monitor your heart and can treat any abnormal rhythms that develop.

Other risks include:

• Allergic reaction to the contrast dye
• Damage to the blood vessel as the needle and catheter are inserted
• Blood clot traveling to the lungs, causing an embolism
• Excessive bleeding or a blood clot where the catheter is inserted, which can reduce blood flow to the leg
• Heart attack or stroke
• Hematoma (a collection of blood at the site of the needle puncture)
• Injury to the nerves at the puncture site
• Kidney damage from the dye
• Injury to blood vessels in the lung
• Bleeding into the lung
• Coughing up blood
• Respiratory failure
• Death

There is low radiation exposure. Your provider will monitor and regulate the x-rays to provide the least amount of radiation exposure. Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks for x-rays.

Considerations

Computed tomography (CT) angiography of the chest has largely replaced this test.

References

Hartman IJC, Screaton NJ. Pulmonary circulation and pulmonary thromboembolism. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 16.

Nazeef M, Sheehan JP. Venous thromboembolism. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2023. Philadelphia, PA: Elsevier; 2023:952-962.

Reekers JA. Angiography: principles, techniques and complications. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 78.

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