RSS Feeds
Ultrasonography of Leg Veins in Patients Suspected of Having Pulmonary Embolism
- Arnaud Perrier, MD; and
- Henri Bounameaux, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
In their study on the diagnostic utility of lower-limb venous compression ultrasonography in patients suspected of having pulmonary embolism [1], Turkstra and colleagues found that ultrasonography had a sensitivity of 29% (95% CI, 22% to 37%) and a specificity of 97% (CI, 94% to 99%). On the basis of these results (a low sensitivity and a suboptimal positive predictive value), they conclude that “compression ultrasonography should be used with great caution in patients suspected of having pulmonary embolism.”
We disagree with that conclusion on several grounds. First, the low sensitivity may be explained by the inclusion of both inpatients and outpatients. In our recent outcome study of 671 consecutive outpatients presenting to an emergency department with suspected pulmonary embolism [2] (in which we used an ultrasonography protocol similar to that used by Turkstra and colleagues), we found a higher sensitivity-51% (CI, 44% to 58%). On the other hand, in an ongoing study of inpatients, sensitivity of ultrasonography seems lower (approximately 30%) in patients hospitalized in medical and surgical wards; this probably reflects a higher proportion of deep venous thrombosis of the calf in this population.
Second, the specificity of ultrasonography (97%) is identical to that of lung scanning [3], which is universally accepted (including by Turkstra and colleagues) as a diagnostic standard for pulmonary embolism. Thus, the proportion of patients inappropriately treated on the basis of ultrasonography results or of a high-probability lung scan are not different. Finally, in a recent economic analysis [4] that was based on the results of a large management trial [5], we showed that combining ultrasonography alone with lung scanning and angiography was marginally cost-effective and that the association of plasma d-dimer measurement and ultrasonography yielded substantial savings.
In conclusion, we believe that ultrasonography is a useful instrument in outpatients suspected of having pulmonary embolism because it yields a highly probable diagnosis of thromboembolic disease in up to 15% of patients in whom this disorder is suspected.
Arnaud Perrier, MD
Henri Bounameaux, MD
Geneva University Hospital; CH-1211 Geneva 14, Switzerland
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
