Pulmonary angiography: a Cath Lab 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Pulmonary angiography in one minute
What it is: X-ray pictures of the pulmonary arteries, which carry blood from the heart to the lungs, taken while contrast dye is injected through a catheter.
Who it is for: people with long-standing clots in the lung arteries, pulmonary hypertension, or narrowings of the lung arteries, often to plan treatment.
Main risks: bruising at the access site, brief rhythm disturbances, reactions to the dye and, rarely, damage to a lung artery.
Usually: under local anaesthetic, 30–60 minutes, often combined with right heart catheterisation.
On this page: What is pulmonary angiography? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in the lab? · FAQ
Catheter in the pulmonary artery, with contrast in the lungs.
What is pulmonary angiography?
The pulmonary arteries take blood from the right ventricle to the lungs to pick up oxygen.
- a catheter is passed through a vein, through the right side of the heart, into the pulmonary artery
- contrast dye is injected while X-ray pictures are taken, one lung at a time
- the pictures show narrowings, blockages from old clots, or abnormal connections
CT scans are used for most new suspected clots. Catheter pulmonary angiography is mainly used in specialist centres, for example to plan treatment for chronic clot disease (CTEPH).
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- chronic thromboembolic pulmonary hypertension (CTEPH), to plan surgery or balloon treatment
- narrowings of the lung arteries, for example in congenital heart disease
- abnormal connections between lung arteries and veins
- unclear CT findings
The decision is made by your heart team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
It can be planned in advance or done urgently. Before it, you usually have:
- blood tests, including kidney function and blood count
- an ECG, and often an echo or other scan
- a review of your medicines, especially blood thinners and diabetes medicines, as per centre protocol
- a chance to ask questions and give consent
Step by step
1. Getting ready
You lie on the X-ray table. ECG, blood pressure and oxygen levels are monitored. The skin over the access site is cleaned and numbed with local anaesthetic; some people also have light sedation, as per centre protocol.
2. Access
A sheath is placed in a vein, usually in the groin, neck or arm, sizes per device and operator. Right heart pressures are often measured first.
3. Pictures
- A. Right heart. The catheter is passed through the right atrium and ventricle.
- B. Into the lung artery. It is guided into the right or left pulmonary artery.
- C. Injection. Dye is injected while pictures are taken; you may cough or feel warm.
- D. Other side. The catheter is moved to the other lung and the pictures repeated.
4. Finishing
The catheters are removed. The sheath is taken out and the site closed with pressure, a band or a closure device, per device and operator.
Recovery and aftercare
- First hours: you rest while the nurses check the access site, pulse and blood pressure, as per centre protocol.
- Going home: usually the same day, with someone to take you home.
- Access site: avoid heavy lifting and strenuous activity for a few days; a small bruise is common.
- Results: the team will usually explain the findings before you go home, and send a report to your own doctor.
- Driving: ask your team; for a planned test it is often a couple of days, but it depends on your heart condition.
Call 999 if you have chest pain, breathlessness, fainting, signs of a stroke, or heavy bleeding or swelling at the access site.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- bruising or bleeding at the access site (common, usually minor)
- damage to the artery or vein at the access site (uncommon)
- reaction to the contrast dye, or effects on kidney function
- heart rhythm disturbances, usually brief
- heart attack, stroke or serious complications (rare)
- X-ray exposure, kept as low as possible
- rarely, injury to a lung artery, causing coughing up blood
Cath lab kit list (printable)
Barts example kit list
An example from one UK centre, written generically. Every lab has its own protocol, and sizes and doses vary.
- venous sheath, size per device and operator
- balloon-tipped or angled catheter for the pulmonary artery, per operator
- guidewire, per operator
- contrast pump, de-aired
- pressure transducer for right heart pressures
- contrast, volume as per centre protocol
Procedural steps (Barts example)
- Venous access
- Right heart pressures
- Catheter to the right pulmonary artery; injection with recording
- Catheter to the left pulmonary artery; injection with recording
- Catheter out; haemostasis
First time in the cath lab?
đź’ˇ First-time tip
- Know the pressures. High lung pressures change how much dye is used.
- Expect a cough. Dye in the lung arteries often triggers a cough.
- Two views per lung. Usually more than one angle is recorded.
- Watch the rhythm. Crossing the right ventricle can cause extra beats.
FAQ
Is this the same as a CT pulmonary angiogram?
No. A CT scan is done in a scanner. This test uses a catheter in the cath lab.
Why might I need both?
The catheter test gives more detail for planning treatment.
Will it hurt?
Most people feel only the local anaesthetic and a warm flush.
Related Cath Lab 101 guides
Sources
All checked on 10 October 2026. Each page's own date is shown where it gives one.
- Baumgartner H, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021;42(6):563–645. PubMed 32860028
- British Heart Foundation. Tests and procedures. bhf.org.uk/informationsupport/tests
- StatPearls (NCBI Bookshelf), search: pulmonary angiography. ncbi.nlm.nih.gov/books
Disclaimer
Education only. This page is for general education for healthcare students, cath lab staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, heart team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a heart emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
