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V/Q, ultrasound in lieu of CT-angiography for diagnosis of PE
Salaun et al publish their experience using a simple algorithm for management of 321 consecutive patients with suspected pulmonary embolism at one center in France. The tool sought to avoid CT-angiography (and associated radiation) wherever possible, instead favoring leg ultrasounds and ventilation-perfusion scans. Only the indeterminate cases (a mere 35, or 11%) underwent CT-A. In all, 98 people were diagnosed with and treated for PE. Of the patients "ruled out" for pulmonary embolism, only 1 had a clinical PE over the next 3 months (0.53%).
The authors acknowledge they had a higher-than-expected rate of diagnosed PE, with the possibility of their algorithm's overdiagnosing/overtreating false-positive PEs. Since these were largely considered unprovoked PEs, patients with false-positive results would presumably be recommended to receive unneeded and dangerous lifelong anticoagulation, by ACCP guidelines. These implications, and the long-term anticoagulation strategies in these patients, were not discussed. CHEST 2011;139:1294-1298.