On Purple Emperors, Pulmonary Embolism, and Venous Thrombosis
Authors: ROGER H. SECKER-WALKER
Journal: Annals of Internal Medicine (1983)

Editorials1 June 1983On Purple Emperors, Pulmonary Embolism, and Venous ThrombosisROGER H. SECKER-WALKER, M.B.ROGER H. SECKER-WALKER, M.B.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-98-6-1006 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDuring the winter of 1977, the emperor of embolism stalked the land, shivering, no doubt, in his underwear! Since Dr. Eugene Robin spoke up, like the young child in the fairy story, challenging conventional widsom, retrospective studies have been published clarifying and refining the interpretation of ventilation-perfusion studies (1-6). Impedance plethysmography has gained stature as a safe and reliable noninvasive test for venous thrombosis in the popliteal fossa, or deep veins of the thigh (7, 8). Pulmonary angiography, the "gold" standard (1), with a mortality rate of 0.5% (9), remains the final arbiter, short of autopsy (10, 11).The diagnosis...References1. ROBIN E. Overdiagnosis and overtreatment of pulmonary embolism: the emperor may have no clothes. Ann Intern Med. 1977;87:775-81. LinkGoogle Scholar2. BIELLOMATTARMCKNIGHTSIEGEL DARB. Ventilationperfusion studies in suspected pulmonary embolism. AJR. 1979;133:1033-7. CrossrefMedlineGoogle Scholar3. ALDERSONBIELLOKHANBARTHMCKNIGHTSIEGEL PDAKRB. Comparison of 133Xe single-breath and washout imaging in the scintigraphic diagnosis of pulmonary embolism. Radiology. 1980;137:481-6. CrossrefMedlineGoogle Scholar4. ALDERSONBIELLOSACHARIAHSIEGEL PDKB. Scintigraphic detection of pulmonary embolism in patients with obstructive pulmonary disease. Radiology. 1981;138:661-6. CrossrefMedlineGoogle Scholar5. MCNEIL B. Ventilation-perfusion studies and the diagnosis of pulmonary embolism: concise communication. J Nucl Med. 1980;21:319-23. MedlineGoogle Scholar6. BOGRENBERMANVISMARAMASON HDLD. Lung ventilation-perfusion scintigraphy in pulmonary embolism: diagnostic specificity compared to pulmonary angiography. Acta Radiol Diagn. 1978;19:933-44. CrossrefMedlineGoogle Scholar7. HULLHIRSHSACKETT RJD. Replacement of venography in suspected venous thrombosis by impedance plethysmography and 125I-fibrinogen leg scanning: a less invasive approach. Ann Intern Med. 1981;94:12-5. LinkGoogle Scholar8. HULLHIRSHSACKETT RJD. Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis: an alternative to venography. N Engl J Med. 1977;296:1497-500. CrossrefMedlineGoogle Scholar9. ALDERSONGOTTSCHALK PA. Ventilation-perfusion studies for pulmonary embolism: a rebuttal to Dr. Eugene Robin [Letter]. Semin Nucl Med. 1979;9:145-6. CrossrefMedlineGoogle Scholar10. NOVELLINEBALTAROWICHATHANASOULISWALTMANGREENFIELDMCKUSICK ROCAAK. The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriograph. Radiology. 1978;126:561-7. CrossrefMedlineGoogle Scholar11. DALENBROOKSJOHNSON JHL. Pulmonary angiography in acute pulmonary embolism: indications, techniques, and results in 367 patients. Am Heart J. 1971;81:175-85. CrossrefMedlineGoogle Scholar12. ALDERSONRUJANAVECHSECKER-WALKERMCKNIGHT PNRR. The role of 133Xe ventilation studies in the scintigraphic detection of pulmonary embolism. Radiology. 1976;120:633-40. CrossrefMedlineGoogle Scholar13. POULOSEREBAWAGNER KRH. Characterization of the shape and location of perfusion defects in certain pulmonary diseases. N Engl J Med. 1968;279:1020-5. CrossrefMedlineGoogle Scholar14. MCDOUGALLGORISKRISS IMJ. Pulmonary embolism [Letter]. Ann Intern Med. 1978;88:711. LinkGoogle Scholar15. ROBIN E. Pulmonary embolism [Letter]. Ann Intern Med. 1978;88:713-5. Google Scholar16. KIPPERMOSERKORTMANASHBURN MKKW. Longterm follow-up of patients with suspected pulmonary embolism and a normal lung scan: perfusion scans in embolic suspects. Chest. 1982;82:411-5. CrossrefMedlineGoogle Scholar17. MCNEIL B. A diagnostic strategy using ventilation-perfusion studies in patients suspect for pulmonary embolism. J Nucl Med. 1976;17:613-6. MedlineGoogle Scholar18. BIELLOMATTAROSEI-WUSUALDERSONMCNEILSIEGEL DAAPBB. Interpretation of indeterminate lung scintigrams. Radiology. 1979;133:189-94. CrossrefMedlineGoogle Scholar19. HULLHIRSHCARTER RJC. Pulmonary angiography, ventillation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med. 1983;98:891-9. LinkGoogle Scholar20. STAMATAKISKAKKARLAWRENCEBENTLEY JVDP. The origin of thrombi in the deep veins of the lower limb: a venographic study. Br J Surg. 1978;65:449-51. CrossrefMedlineGoogle Scholar21. KAKKARHOWEFLANCCLARKE VCCM. Natural history of postoperative deep-vein thrombosis. Lancet. 1969;2:230-2. CrossrefMedlineGoogle Scholar22. ALDERSONLEESUMMERMOTAZEDIWAGNER PHWAH. Comparison of Xe-133 washout and single-breath imaging for the detection of ventilation abnormalities. J Nucl Med. 1979;20:917-22. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of Vermont Burlington, Vermont PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByGas Exchange and Pulmonary Hypertension following Acute Pulmonary Thromboembolism: Has the Emperor Got Some New Clothes Yet?Deep Venous Thrombosis ProphylaxisStrategy for Diagnosis of Patients With Suspected Acute Pulmonary EmbolismIn Reply: Testing For Pulmonary EmbolismPulmonary embolismClinical Validity of a Normal Perfusion Lung Scan in Patients with Suspected Pulmonary EmbolismA Comparative Study of Intravenous Digital Subtraction Angiography and Ventilation-Perfusion Scans in Suspected Pulmonary EmbolismAcute and chronic pulmonary thromboembolism: current perspectives part viii: summaRy and referencesPulmonary thromboembolism: Current status report on the role of nuclear medicineRoutine Electrocardiograms on AdmissionDONALD A. OPILA, M.D.Diagnosis of Pulmonary EmbolismJOHN T. PHILBRICK, M.D. 1 June 1983Volume 98, Issue 6Page: 1006-1008KeywordsAngiographyAutopsyDeath ratesPulmonary embolismRetrospective studiesThrombosisVeinsVentilation perfusion Issue Published: 1 June 1983 PDF DownloadLoading ...