Answer:

A. Ventilation/perfusion scan

Discussion


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RV hypertrophy and RV enlargement in single-photon emission computed tomography is pathognomonic for pulmonary hypertension. This patient did not have pulmonary hypertension before starting chemotherapy. Furthermore, her history of cancer complicated by a long hospital stay for sepsis suggests she was/is at risk for chronic pulmonary embolic disease.

A ventilation/perfusion scan is the preferred test for diagnosing chronic thromboembolic disease as the underlying etiology for pulmonary hypertension.1 If the ventilation/perfusion scan is negative, then right heart catheterization maybe helpful; however, there is no indication for a left heart catheterization (choice B).1 There are no clues in the clinical presentation to suggest this patient has chronic obstructive pulmonary disease; thus, choice C would not be the next best step. Choice D can often be helpful in the work-up of mild pulmonary hypertension, when noninvasive screening suggests the patient may have obstructive sleep apnea. However, there are no clues in the stem to suggest she has obstructive sleep apnea.1 Finally, a cardiac magnetic resonance imaging scan would not be helpful in this setting.

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Reference

  1. Galiè N, Humbert M, Vachiery JL, et al; on behalf of the ESC Scientific Document Group. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congential Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67-119.