Editorials

Imaging pulmonary embolism

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7130.490 (Published 14 February 1998) Cite this as: BMJ 1998;316:490

A new look with spiral computed tomography

  1. David M Hansell, Consultant radiologista,
  2. Christopher D R Flower, Consultant radiologistb
  1. a Department of Radiology, Royal Brompton Hospital, London SW3 6NP
  2. b Department of Radiology, Addenbrooke's Hospital, Cambridge CB2 2QQ

    Pulmonary embolism is a common condition that often escapes diagnosis in life. The mortality attributable to pulmonary embolism depends on many factors but can be up to 30% in untreated patients, more than 10 times the annual mortality for patients treated with anticoagulant drugs (2.5%).1 Balanced against the danger of underdiagnosis are the risks of treatment with anticoagulants.2 Investigation is often haphazard and treatment empirical, reflecting the relative insensitivity and poor specificity of traditional non-invasive diagnostic tests such as ventilation/perfusion (V/Q) scintigraphy.3 In an attempt to improve diagnostic precision, many studies have recommended combinations of tests.4 5 6 Pulmonary arteriography is justly regarded as the final arbiter, but it is underused and is available in only a third of hospitals in the United Kingdom.7

    Spiral computed tomography images the pulmonary vessels directly. It is non-invasive and increasingly available. During a scan, which is performed in a single breath hold, intravenous contrast medium is given, and …

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