The article by Girard et al published in this issue
of CHEST (see page 903) is a retrospective review that is
unlikely to be repeated. The data were collected between 1984 and 1988
and presented at an annual meeting in 1990. The data were not submitted
for peer review until nearly a decade later.
The population examined in this study consisted of patients with
angiographically proven pulmonary emboli (PE). No data are presented to
be able to ascertain the results of ventilation/perfusion
(V̇/Q̇) scans that may have proceeded the angiograms.
Patients with a diagnostic pulmonary angiogram then underwent bilateral
lower-extremity venography. Since the treatment for deep venous
thrombosis (DVT) and PE are the same, why do venography at all?
The authors state that it was a practice in France at the time of this
investigation to look for free-floating thrombi (FFT) and, if present,
to place an inferior vena cava filter to prevent potentially lethal
recurrent emboli. Although this practice is debated,1–3
given the frequency of PE due to FFT, it would be reasonable in certain
high-risk patients (those with a large pulmonary clot load plus FFT,
for example). Unfortunately, FFT is not clearly defined by the authors.
Were the clots moving within the vein, or did FFT represent only fresh
clot that had not yet attached to the vessel wall? Is venography
superior to ultrasound in determining this?