Over the past years, CT scanning has gained a prominent role in the diagnostic management of pulmonary embolism (PE), especially with the introduction of multi-detector row CT scanning. Recently, Righini et al. [1] performed a study which convincingly showed that venous compression ultra-sonography of the legs is not needed to rule out pulmonary embolism (PE) when a clinical decision rule, D-dimer testing and multidetector-row CT (MDCT) scan are used in patients with suspected PE. With this conclusion, this well-designed and large prospective study seems to have given an answer to the question of whether a normal CT scan alone is sufficient to exclude the diagnosis. What has remained debatable, however, is whether a normal CT scan is also safe to exclude PE in the subgroup of patients with a high clinical pretest probability for PE (i.e. an apparent discrepancy between the clinical pretest probability and the normal findings on the CT scan).
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