Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
You state 'If CT pulmonary angiography is not performed, then pulmonary emboli will be missed, as will the opportunity to make other important diagnoses, such as pneumonia or small lung cancers'. This is concerning as pneumonia can be indistinguishable from pulmonary infarction and a CTPA examination often excludes lung apices and bases where small cancers can reside and therefore be missed.
Regarding CTPA as an opportunistic test is dangerous, it should not replace clinical examination and evidence based risk assessment.
A CTPA has its limitations and these should be discussed with a radiologist before advocating such liberal and reckless use.
Re: Risk-benefit ratio favours treating all pulmonary emboli, no matter how small
Dear Sir,
You state 'If CT pulmonary angiography is not performed, then pulmonary emboli will be missed, as will the opportunity to make other important diagnoses, such as pneumonia or small lung cancers'. This is concerning as pneumonia can be indistinguishable from pulmonary infarction and a CTPA examination often excludes lung apices and bases where small cancers can reside and therefore be missed.
Regarding CTPA as an opportunistic test is dangerous, it should not replace clinical examination and evidence based risk assessment.
A CTPA has its limitations and these should be discussed with a radiologist before advocating such liberal and reckless use.
Competing interests: No competing interests