We would like to thank Dr Fred for his reply to our article.1 It enabled us to become familiar with some of the earlier literature that we had not read previously. Dr Fred criticizes our article in two areas. First, we carefully reviewed the references he has cited. Despite a suspicion of pulmonary embolism in a number of patients, none of these studies2-4 provide a well-documented case in which pulmonary embolism is associated with chest wall tenderness. McMillian2 mentioned one case in which autopsy was performed, but he gives no details of the patient's course or autopsy examination. Although documentation of pulmonary embolism is inadequate in these studies, the suggestion of an association between chest wall tenderness and pulmonary embolism seems to add credence to our article. Additionally he cites two review articles5,6 written in 1964 that were based on the forementioned studies of McMillan,2
Weiland DS, Dreyfuss AI, Arlington A. Diagnostic Considerations in Chest Wall Tenderness-Reply. Arch Intern Med. 1985;145(6):1141–1142. doi:10.1001/archinte.1985.00360060209041
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