CHEST Guidelines-Comprehensive-Clinical-Evidence-for-Pulmonary-Embo

Comprehensive-Clinical-Evidence-for-Pulmonary-Embo

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The correspondence published in CHEST in December 2014 by Dr. Giovanni Volpicelli and Dr. Peiman Nazerian responds to concerns raised by Maggi et al. regarding an article on the accuracy of point-of-care multiorgan ultrasonography for diagnosing pulmonary embolism (PE). The authors address several points raised by Maggi et al., clarifying their methodologies and findings.<br /><br />Firstly, they acknowledge that dorsal scans were not performed in some cases, but emphasize that patient positioning during ultrasound examinations typically allows them to conduct necessary tests in emergency settings. They argue that the patient's position does not significantly interfere with detecting peripheral infarctions, although scanning dorsal areas can be crucial.<br /><br />Secondly, Volpicelli and Nazerian respond to references cited by Maggi et al., distinguishing between a scientifically valid study that inspired their protocol and a less reliable review article based on personal interpretations.<br /><br />Thirdly, they confirm that the reported number and locations of pulmonary infarcts in their study are accurate and consistent between the text and figures. They clarify a misquoted statement by Maggi et al., affirming that their article noted, "77 patients showed at least one subpleural infarct."<br /><br />Fourthly, regarding the detection of deep vein thrombosis (DVT) in patients suspected of PE, they stress that such detection justifies anticoagulant treatment without needing further testing. They found that in patients without DVT but with positive lung and heart ultrasonography, most were ultimately diagnosed with PE.<br /><br />Finally, they reiterate that their study suggested multi-organ ultrasonography could reduce unnecessary CT scans in symptomatic PE patients. They caution against assumptions made about their findings, emphasizing that test accuracy varies by specific settings and patient conditions.<br /><br />The correspondence reaffirms their study's validity and discounts unsupported claims, contributing to a nuanced understanding of ultrasound's role in PE diagnosis.

Keywords

point-of-care ultrasonography

pulmonary embolism

dorsal scans

patient positioning

pulmonary infarcts

deep vein thrombosis

anticoagulant treatment

multi-organ ultrasonography

CT scans

test accuracy