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Pulmonary Arteriography: The Gold Standard

Richard D. Sautter, MD
Arch Intern Med. 1987;147(2):202-205. doi:10.1001/archinte.1987.00370020022012.
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To the Editor.  —I read with great interest the article entitled "Diagnosing Pulmonary Embolism Using Clinical Findings" by Hoellerich and Wigton,1 but their suggestion regarding the "decision rule" left me incredulous.Why in the world would anyone want to discourage the use of pulmonary arteriography for patients with suspected pulmonary embolism (PE), a potentially lethal disease without prompt treatment? Why would any clinician not wish to have a clear, positive or negative diagnosis established with one simple procedure?Pulmonary arteriography in a reasonably equipped hospital can usually be done in less time than pulmonary scans. The mortality rate from pulmonary arteriography in one series was three deaths (0.2%) in 1350 procedures.2 The mortality rate of untreated PE is reported to be as high as 30%.3 A negative result shown on a pulmonary arteriogram is of great value because anticoagulant therapy can be avoided, which is quite important as


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