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Most diagnostic algorithms for pulmonary embolism (PE) include visualization of the deep veins of the leg for selected patients. However, recent cohort studies have suggested that the enhanced sensitivity of multislice computerized tomography (MSCT) of the chest makes leg-vein visualization unnecessary.
In a randomized test of this hypothesis, investigators assigned 1819 outpatients with clinically suspected pulmonary embolism to one of two diagnostic strategies. In one strategy (DD-US-CT), patients with high clinical probability of PE, and those with lower clinical probability but positive D-dimer tests, underwent leg ultrasound, followed by MSCT if no evidence of deep-vein thrombosis was present. In the second strategy (DD-CT), high-risk p…