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Ultrasound in Suspected Pulmonary EmbolismUltrasound in Suspected Pulmonary Embolism FREE TO VIEW

Carla Nobre, MD; Boban Thomas, MD, FCCP
Author and Funding Information

From the Department of Internal Medicine (Dr Nobre) and Department of Cardiology (Dr Thomas), Centro Hospitalar Barreiro Montijo.

CORRESPONDENCE TO: Boban Thomas, MD, FCCP, Centro Hospitalar Barreiro Montijo - Cardiology, Barreiro, Barreiro 1900-280, Portugal; e-mail: bobantho@gmail.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):e109. doi:10.1378/chest.14-0858
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Published online
To the Editor:

Although we applaud the effort by Koenig and colleagues1 presented in a recent issue of CHEST (April 2014) to transmit the message that point-of-care ultrasonography may help to avoid unnecessary CT pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE), we wish to raise a few concerns regarding the study. We believe the fact that only 12 patients (12.5%) undergoing a CPTA had a PE diagnosed reflects poor clinical decision-making. There was no mention in the article about either the Wells score or revised Geneva score in this cohort, which may have helped us to understand the real need for a CTPA in these patients. As experienced clinicians, we believe that the patterns discovered by the authors on ultrasonography, namely alveolar consolidation, pleural effusion, and pulmonary edema, can be detected by a plain chest radiograph most of the time, and alveolar consolidation and pulmonary edema can be suspected from a proper clinical history and chest examination. The chest radiograph findings are not presented as well.

Some studies have suggested that gestalt assessment may perform better than clinical decision rules, but the low number of PEs detected in this group calls for a better method for selecting patients to undergo CTPA for suspected PE.2 Although lung ultrasonography may avoid unnecessary CTPAs in patients with PE, good clinical judgment may be even more effective.

References

Koenig S, Chandra S, Alaverdian A, Dibello C, Mayo PH, Narasimhan M. Ultrasound assessment of pulmonary embolism in patients receiving CT pulmonary angiography. Chest. 2014;145(4):818-823. [CrossRef] [PubMed]
 
Penaloza A, Verschuren F, Meyer G, et al. Comparison of the unstructured clinician gestalt, the Wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med. 2013;62(2):117-124. [CrossRef] [PubMed]
 

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References

Koenig S, Chandra S, Alaverdian A, Dibello C, Mayo PH, Narasimhan M. Ultrasound assessment of pulmonary embolism in patients receiving CT pulmonary angiography. Chest. 2014;145(4):818-823. [CrossRef] [PubMed]
 
Penaloza A, Verschuren F, Meyer G, et al. Comparison of the unstructured clinician gestalt, the Wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med. 2013;62(2):117-124. [CrossRef] [PubMed]
 
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