Correspondence (letter to the editor): Remember Transthoracic Ultrasonography

The article has great relevance to clinical practice and reflects the prevailing opinion in Germany (1). However, in their literature review, the authors unfortunately did not come across the very readable meta-analysis by T Niemann from University Hospital Basel, on the importance of transthoracic ultrasonography (TUS) in the diagnostic evaluation of acute pulmonary embolism (2). This meta-analysis shows a sensitivity of 80% and a specificity of 93% if only prospective studies are included; these results are no worse than those obtained by multidetector computed tomography (MDCT) in diagnosing pulmonary embolism.

Minimizing exposure to radiation has become an important topic in radiology, especially since CT scanning was introduced, and European initiatives are searching for alternative diagnostic methods (SPECT-protocol). TUS is the obvious choice in this setting, since it is available everywhere and easy to learn, as well as offering valid results. In emergency units and intensive care wards in patients who cannot be transported it even has advantages compared with MDCT. A further advantage lies in the fact that it is possible using one soundhead to expose the deep leg veins (source), the right heart (place of transmission), and the lung as the target organ of the embolism. If one assumes a combination of deep vein thrombosis in the leg with acute pulmonary embolism in 80% of cases , this is enormously important for rapid initiation of anticoagulation. Pneumologists have learnt TUS in recent years, and the procedure has become a standard tool in pneumology clinics.

Unfortunately, TUS has hitherto not been included in any national or international guidelines. This really should change sooner rather than later.