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Stripe Sign

Kathleen S Lee, MD
J Stevan Nagel, MD

October 5, 1995

Presentation

A 52-year-old man presented with chest pain and shortness of breath.

Imaging Findings

Plain radiographs, PA and lateral
Ventilation-perfusion scintigraphy
Pulmonary arteriography

Posteroanterior (PA) and lateral radiographs of the chest show low lung volumes, a small left pleural effusion (PA with arrow) (Lateral with arrow) and cardiomegaly. The lungs are clear.

Pulmonary ventilation and perfusion scintigraphy using technetium-99m MAA (macroaggregated albumin) and xenon-133 gas was subsequently performed. Planar lung perfusion images show a nonsegmental, horizontally oriented perfusion defect in the left lung base involving multiple basal segments (arrows). Immediately peripheral to this defect, a stripe of retained radiotracer uptake (arrows) indicates that the perfusion defect does not extend to the pleural surface. A matching left basilar defect is visible on ventilation images in the left posterior oblique (LPO) projection (arrow). No other perfusion or ventilation abnormalities are present.

The ventilation-perfusion study was interpreted as low probability for pulmonary embolism. Yet because of high clinical suspicion for pulmonary embolism, a pulmonary arteriogram was obtained. This study shows crowding of left basilar pulmonary vasculature consistent with atelectasis (arrow), but no evidence of pulmonary embolism.

Diagnosis

Atelectasis

Discussion

The presence of a stripe sign on pulmonary perfusion scintigraphy, in the absence of other abnormalities, indicates a low probability for pulmonary embolism. The stripe sign is usually associated with atelectatic lung. In contrast to the stripe sign, pulmonary emboli usually extend peripherally to the pleural surface. In most situations with a stripe sign, a pulmonary angiogram is not necessary. It was obtained in this instance because of high pretest clinical suspicion for embolism.

References

1. Guiberteau MJ, Mettler FA. Essentials of nuclear medicine imaging. Orlando: Grune and Stratton, 1991.

2. Datz FL, et al. Nuclear medicine: a teaching file. St Louis: Mosby, 1992.

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