Ultrasound in suspected pulmonary embolism.

Although we applaud the eff ort by Koenig and colleagues 1 presented in a recent issue of CHEST (April 2014) to transmit the message that point-of-care ultrasonography may help to avoid unnecessary CT pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE), we wish to raise a few concerns regarding the study. We believe the fact that only 12 patients (12.5%) undergoing a CPTA had a PE diagnosed refl ects poor clinical decision-making. Th ere was no mention in the article about either the Wells score or revised Geneva score in this cohort, which may have helped us to understand the real need for a CTPA in these patients. As experienced clinicians, we believe that the patterns discovered by the authors on ultrasonography, namely alveolar consolidation, pleural eff usion, and pulmonary edema, can be detected by a plain chest radiograph most of the time, and alveolar consolidation and pulmonary edema can be suspected from a proper clinical history and chest examination. Th e chest radiograph fi ndings are not presented as well.