What imaging study is utilized for pleuritic pain with a normal CXR when a pulmonary embolism is suspected?

When a patient presents with pleuritic pain and a normal chest X-ray (CXR) is observed, yet there is a strong suspicion of pulmonary embolism (PE), the most appropriate imaging study to pursue is a ventilation-perfusion (V/Q) scan. A V/Q scan assesses the distribution of air (ventilation) and blood (perfusion) in the lungs, helping to identify any mismatches that would suggest a PE.

In cases where the CXR is normal, it indicates that there are no obvious signs of lung pathology, such as pneumonia or pleural effusion. However, a normal CXR does not rule out PE, which is a critical diagnosis to consider when patients present with acute pleuritic chest pain, especially if they have risk factors for thromboembolic disease.

The V/Q scan is particularly useful in patients who may not be able to tolerate a CT scan due to contraindications like renal impairment or iodine allergy, or in cases where the patient is pregnant and minimizing radiation exposure is a priority. This scanning method can effectively provide information regarding perfusion defects consistent with PE.

While a CT scan, particularly CT pulmonary angiography (CTPA), is often considered the first-line imaging for suspected PE due to its high