Letters When a test is too good

Most patients with isolated subsegmental pulmonary embolism do not need anticoagulants

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5127 (Published 20 August 2013) Cite this as: BMJ 2013;347:f5127
  1. Sananda Haldar, specialty registrar in clinical radiology1,
  2. Akshay Garg, foundation year 1 doctor1,
  3. Steve Barden, consultant acute physician1,
  4. Guy Burkill, consultant radiologist1,
  5. Nigel Marchbank, consultant radiologist1
  1. 1Brighton and Sussex University Hospital NHS Trust, Brighton BN2 5BE, UK
  1. sanandahaldar{at}gmail.com

We agree with Wiener and colleagues that widespread use of computed tomography (CT) pulmonary angiography is partly responsible for the overdiagnosis of pulmonary embolism.1

In a recent year long study of CT pulmonary angiography in our acute trust, we reviewed all patients reported as having isolated subsegmental pulmonary embolism (ISSPE). All scans originally reported as showing ISSPE were reviewed by two chest radiologists, who rejected the diagnosis if it was not visible on multiplanar reformats.

During this period, 91.7% (1317/1435) of studies were technically adequate. Of these, 21% had a positive …

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