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October 9, 1987

Roentgenograms in Pericardial Effusion

JAMA. 1987;258(14):1890. doi:10.1001/jama.1987.03400140052011

To the Editor.—  We appreciate the methods used by Heinsimer et al1 in their article entitled "Supine Cross-Table Lateral Chest Roentgenogram for the Detection of Pericardial Effusion" in the June 19, 1987, issue of JAMA, but disagree with their conclusions. Based on improved sensitivity, specificity, and predictive values compared with a standard chest roentgenogram, they recommend that a supine cross-table lateral (SCTL) film be included in the evaluation of patients with suspected pericardial effusion or in patients in whom a large cardiac silhouette is detected on a standard chest roentgenogram. However, the test characteristics may not accurately reflect the true clinical utility of the additional roentgenogram view. Given the preroentgenogram probability of pericardial effusion of 60% in their study population, the positive and negative predictive values for a two-view chest roentgenogram are 73% and 44%, and 78% and 51% for the SCTL view. The incremental gain in information by