Interest of chest x-ray in tailoring the diagonsotic strategy in patients with suspected pulmonary embolism

Objectives Current diagnostic strategies for pulmonary embolism (PE) rely on the sequential use of non-invasive diagnostic tests including ventilation-perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA). V/Q scan remains criticized because of a high proportion of non-diagnostic test results especially when the chest X-ray (CXR) is abnormal. The present study assesses whether CXR results have an impact on the conclusiveness of a non invasive diagnostic strategy of PE based on the combination of pretest probability, compression ultrasonography, V/Q scan and CTPA.

Methods Patients suspected of having PE were managed according to a validated diagnostic strategy. All patients underwent a CXR within 24 hours of the suspicion of PE. CXR results were correlated to strategy conclusiveness, as assessed by the rate of required CTPA as per the diagnostic algorithm.

Results Two hundred and twenty three patients were retrospectively analysed. CXR were considered as normal in 108 (48 %) patients and abnormal in 115 (52 %) patients. According to the diagnostic algorithm, a CTPA was required to reach a diagnostic conclusion in 11 (10 %) patients of the normal CXR group, and in 14 (12 %) patients of the abnormal CXR group (p > 0.05).

Conclusions In this study, the presence of CXR abnormalities did not have an impact on the conclusiveness of a diagnostic strategy of PE based on V/Q scan. CXR abnormalities should likely not be regarded as a contra-indication to the use of V/Q scan in patients with suspected PE.