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To the Editor: The advantage gained by / scanning in having comparable efficacy with CTPA in ruling out clinically significant pulmonary emboli¹ might be offset by the inability of / scanning to identify clinically significant disorders, including dissecting aortic aneurysm, which can simulate pulmonary embolism in its clinical² and biochemical signs³ and in its ability to generate a / mismatch identical to that generated by pulmonary embolism.⁴ Electrocardiogram-gated 64–multidetector computed tomography angiography may be able to identify both pulmonary embolism and dissecting aortic aneurysm in situations where the origin of chest pain is unclear.⁵ It should be evaluated against / scanning for its ability to rule out pulmonary embolism.

Financial Disclosures: None reported.

Oscar M. Jolobe, MRCP
oscarjolobe@yahoo.co.uk
Manchester Medical Society
Manchester, Lancashire, United Kingdom

1. Anderson DR, Kahn SR, Rodger A; et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007;298(23):2743-2753. FREE FULL TEXT 2. Charnsangavej C. Occlusion of the right pulmonary artery by acute dissecting aortic aneurysm. AJR Am J Roentgenol. 1979;132(2):274-276. ISI | PUBMED 3. Weber T, Hogler S, Auer J; et al. D-dimer in acute aortic dissection. Chest. 2003;123(5):1375-1378. FULL TEXT | ISI | PUBMED 4. Rau AN, Glass MN, Waller BF, Fraiz J, Shaar CJ. Right pulmonary artery occlusion secondary to a dissecting aortic aneurysm. Clin Cardiol. 1995;18(3):178-180. ISI | PUBMED 5. Johnson TR, Nikolaou K, Wintersperger BJ; et al. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. AJR Am J Roentgenol. 2007;188(1):76-82. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;299(14):1664.

RELATED ARTICLE

Computed Tomographic Pulmonary Angiography vs Ventilation-Perfusion Lung Scanning in Patients With Suspected Pulmonary Embolism: A Randomized Controlled Trial
David R. Anderson, Susan R. Kahn, Marc A. Rodger, Michael J. Kovacs, Tim Morris, Andrew Hirsch, Eddy Lang, Ian Stiell, George Kovacs, Jon Dreyer, Carol Dennie, Yannick Cartier, David Barnes, Erica Burton, Susan Pleasance, Chris Skedgel, Keith O’Rouke, and Philip S. Wells
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Excluding Pulmonary Embolism With Computed Tomographic Pulmonary Angiography or Ventilation-Perfusion Lung Scanning
Muhammad Ayaz Mir
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Excluding Pulmonary Embolism With Computed Tomographic Pulmonary Angiography or Ventilation-Perfusion Lung Scanning—Reply
David R. Anderson, Marc A. Rodger, and Philip S. Wells
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