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Editorials |1 February 2000

Helical Computed Tomography and the Diagnosis of Pulmonary Embolism

Shannon M. Bates, MD, FRCP(C); Jeffrey S. Ginsberg, MD, FRCP(C)

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From McMaster University and Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8N 3Z5, Canada

    Grant Support: Dr. Bates is a recipient of a Research Fellowship from the Heart and Stroke Foundation of Ontario. Dr. Ginsberg is a Career Investigator of the Heart and Stroke Foundation of Ontario.

    Requests for Single Reprints: Jeffrey S. Ginsberg, MD, FRCP(C), Thromboembolism Unit, HHSC 3X28 McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada; e-mail, ginsbrgj@fhs.csu.mcmaster.ca.

    Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

    Current Author Addresses: Dr. Bates: Thromboembolism Unit, HHSC Room, 3W15, McMaster University Medical Center, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.

    Dr. Ginsberg: Thromboembolism Unit, HHSC Room 3X28, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.

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FULL TEXT
Acute pulmonary embolism is a common and potentially life-threatening disorder (1). Treatment is highly effective (2) but not without complications, and the diagnosis of pulmonary embolism therefore requires a high degree of certainty. Conversely, if untreated, pulmonary embolism can be fatal.
The clinical diagnosis alone is inaccurate for patients with suspected pulmonary embolism. Pulmonary angiography remains the diagnostic reference standard, but it is invasive and expensive, is not universally available, and is associated with morbidity (in 2% to 5% of patients) and death (in <1% of patients) (3). Ventilation-perfusion scanning, the most commonly used screening technique, provides a probability estimate for pulmonary embolism on the basis of the size and number of perfusion defects. Normal results on ventilation-perfusion lung scanning essentially exclude pulmonary embolism, and a high-probability lung scan is virtually diagnostic when accompanied by high or moderate clinical suspicion (4). However, because approximately two thirds of lung scans are nondiagnostic (4), pulmonary angiography or serial venous ultrasonography (done over 14 days to detect deep venous thrombosis) (5) is often required. Both of these approaches are inconvenient and costly, and angiography can be dangerous.
Recently, tremendous interest and enthusiasm have surrounded the use of helical (spiral) computed tomography (CT) as the initial screening test for patients with suspected acute pulmonary embolism. In fact, some centers use the results of helical CT to manage such patients (6). As shown by Rathbun and colleagues (7) in this issue, however, this approach is risky.
Several criteria should be...
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Bates SM, Ginsberg JS. Helical Computed Tomography and the Diagnosis of Pulmonary Embolism. Ann Intern Med. 2000;132:240–242. doi: 10.7326/0003-4819-132-3-200002010-00012

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Published: Ann Intern Med. 2000;132(3):240-242.

DOI: 10.7326/0003-4819-132-3-200002010-00012

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2000 American College of Physicians
13 Citations

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