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November 28, 1977

Pulmonary Embolism and Pulmonary Angiography

JAMA. 1977;238(22):2366-2367. doi:10.1001/jama.1977.03280230030009

To the Editor.—  We read the remarks by William B. Buckingham, MD, in QUESTIONS AND ANSWERS (237:1377-1378, 1977). Our interest stems from extensive experience with pulmonary embolism and pulmonary angiography as well as long-standing concern over the regrettable lack of angiographic capabilities in many large hospitals and medical centers. We are now further concerned that Dr Buckingham's advice may perpetuate some misconceptions about this situation.He stated that "pulmonary arteriography is usually reserved for cases requiring surgical intervention." In fact, in most centers this is not the case. A quote from Dr Buckingham's own reference, Simon,1 states: "The indication for pulmonary angiography is diagnostic doubt. The risks of the procedure are substantially lower than those with the simplest form of therapy, long-term anticoagulation." The words "invasive" and "risk" used by Dr Buckingham seem to condemn angiography, but, in fact, its morbidity is only 4% and mortality only 0.3%.2