Diagnosing pulmonary embolism

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7093.1550 (Published 24 May 1997) Cite this as: BMJ 1997;314:1550
  1. John A Holemans, Senior registrara,
  2. John F Reidy, Consultant radiologista
  1. a Department of Radiology, Guy's and St Thomas's Hospital, London SE1 9RT
  2. b Hinchingbrooke Hospital, Huntingdon, Cambridgeshire PE18 8NT
  3. c Kingston Hospital NHS Trust, Kingston upon Thames, Surrey KT2 7QB
  4. d Intensive Care Unit, Department of Internal Medicine, Innsbruck University Hospital, A-6020 Innsbruck, Austria
  5. e Department of General Practice, Medical School, University of Birmingham, Birmingham B15 2TT

    Not all procedures are invasive

    Editor—Tony Fennerty sets his review of the diagnosis of pulmonary embolism in the context where pulmonary angiography is not generally available.1 This seems a rather backward looking approach as any modern radiology department performing angiography should be able to perform a pulmonary study. We believe that even when pulmonary angiography is freely available, it is not commonly requested by referring clinicians because they are reluctant to use an invasive procedure that they perceive as dangerous. However, pulmonary angiography with selective angiography using non-ionic contrast medium has a low mortality (<1%) and morbidity (2-5%).2 Fennerty quotes a mortality of 0.1% from treatment with anticoagulants, but this is much lower than in other reported series (1-2% mortality, 5-25% morbidity),2 which suggests that empirical anticoagulation should be avoided. Pulmonary angiography should be requested more often when isotope lung scans show an intermediate or low probability of pulmonary embolism and Doppler studies of the leg veins give negative results, especially when clinical suspicion is high.

    Fennerty gives only a passing reference to the future role of fast computed tomography techniques, despite them having been shown to be as reliable as angiography or isotope scanning in detecting central pulmonary embolism, although not in detecting subsegmental acute emboli.3 The exact role of fast computed tomography has yet to be established, but if available it is a non-invasive alternative to angiography after a non-diagnostic isotope study. If …

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