Correspondence (reply): In Reply

As we mentioned in our article, many methods, or combinations therefore, are available for the reliable diagnostic confirmation or exclusion of pulmonary embolism (1). A more detailed description of the individual investigative methods would have exceeded the remit of a review article.

Weckesser, Trötschel, and Schümichen emphasize the importance of perfusion and ventilation scintigraphy. We agree that scintigraphy is a useful alternative to MDCT if relative contra-indications to the administration of contrast medium exist, as long as the equipment is sufficiently close to be immediately available, even in emergency situations. However, a recent survey showed that ventilation-perfusion scintigraphy is not available round the clock in 23% of participating radiological departments, whereas MDCT is not available 24/7 in only 3% of participating departments (2). It also deserves mention that non-iodine containing contrast media can be administered in most cases of contrast medium allergy, thyroid dysfunctions, or renal failure. In this context we wish the point out the standard operating procedures (SOP) for contrast medium administration at Heidelberg University Hospital (3).

The results of the meta-analysis mentioned by Kirsten about the importance of transthoracic ultrasonography (TUS) in the diagnostic evaluation of acute pulmonary embolism were not reproduced in a recent study (4). Because of the unclear data situation it therefore currently seems unjustified to recommend its use outside study settings. The same is true for endobronchial ultrasonography (EBUS).

We thank Aumiller for his comment about sonography of the leg veins. In hemodynamically stable patients with suspected pulmonary embolism, this diagnosis is regarded as confirmed if sonography shows a venous thrombosis in the leg (5).