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Invited Commentary
November 23, 2009

Computed Tomographic Pulmonary Angiography to Diagnose Acute Pulmonary Embolism: The Good, the Bad, and the UglyComment on “The Prevalence of Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to Diagnose Pulmonary Embolism”

Arch Intern Med. 2009;169(21):1966-1968. doi:10.1001/archinternmed.2009.400

Pulmonary embolism (PE) remains a frequent and potentially fatal diagnosis that is easily missed. Its highly variable and nonspecific presentation mandates both a high index of suspicion and dependence on imaging techniques to confirm and treat PE or rule out the diagnosis.

With the advent of recent technological advances, multidetector computed tomographic pulmonary angiography (CTA) has rapidly become the sine qua non for the workup of PE. No wonder. The 1-minute test, ability to directly visualize clots within the pulmonary arteries, good sensitivity, and widespread availability 24 hours a day form indeed an impressive combination. When all of this is added to the allure of any new, sophisticated, and powerful technology, most suspected cases of acute PE are being currently referred for CTA soon after presentation.1 However, this decision may not be as straightforward as it seems.

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