THE ALVEOLAR-ARTERIAL OXYGEN GRADIENT IN PATIENTS WITH DOCUMENTED PULMONARY-EMBOLISM

It has been reported tht the finding of a normal PaO2 level on arterial blood gas analysis does not exclude the diagnosis of acute pulmonary embolism. We wished to determine whether a more thorough evaluation of the blood gases would prove more helpful; specifically, whehter it is possible for a patient with acute pulmonary embolism to have a normal alveolar-arterial (A-a) oxygen gradient. We studied this question in a patient population in which the diagnosis was definitively made via pulmonary arteriography. Sixty-four patients met all study criteria. In these patients, the A-a gradient ranged from 11.6 to 83.9 mm Hg (mean, 41.8 mm Hg). In three patietns, the A-a gradient was normal for age. We conclude that a normal A-a oxygen gradient does not exclude the diagnosis of acute pulmonary embolism, and should not preclude further diagnostic procedures if there is a high index of suspicion.