Combined Radionuclide Phlebography and V/Q scan in the assessment of iliac vein thrombosis and pulmonary embolism – A case report establishing a cause and effect relationship

Deep vein thrombosis (DVT) is an important life threatening condition that is difficult to diagnose, particularly in the early stages. Looking for DVT in lower limb can be considered ancillary in suspected cases of pulmonary embolism (PE) indirectly highlighting a cause and effect relationship of a single disease (i.e cause being DVT and effect is the assault on the lung vasculature). Prompt and early identification of one or both of these pathologies calls for urgent intervention in the form of instituting anticoagulation therapy. Synthetic Tc-99m labeled peptides like apcitide, a glycoprotein (GP IIb/IIIa) receptor antagonist is increasingly used as a specific tracer in the detection of acute DVT. But due to its non availability in certain countries, one needs to resort to indirect evidence in the form of Tc-99m MAA to help in the identification of DVT.  Radionuclide phlebography (RPh) combined with lung perfusion scintigraphy (LP) is a one stop shop for the rapid and non-invasive diagnostic assessment of PE due to DVT. The aim of this case report is to highlight the underutilization of nuclear techniques in the evaluation of DVT in routine clinical practice. We report a case of a young Indian male who presented with sudden onset dyspnoea. On scintigraphic evaluation by a simultaneous RPh and LP, the cause and effect of DVT could be easily established.