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David Cundiff¹ states that patients with pulmonary embolism (PE) who survive to the point of undergoing diagnostic imaging are a selected group with a "relatively benign prognosis." While we agree that their prognosis is better than that of unselected patients with PE, we would argue that survivors of nonmassive PE who have adequate cardiopulmonary reserve in fact consist of 2 distinct subgroups with quite different prognoses in the absence of treatment, based on the likelihood of PE recurrence. This is, in turn, determined by the presence or absence of residual proximal deep vein thrombosis (PDVT).

Wells et al² showed that the 3-month risk of clinical venous thromboembolism was only 0.5% in untreated patients with a non–high clinical probability of PE, nondiagnostic ventilation-perfusion scan, and serially negative lower limb ultrasound test results over 2 weeks, despite a 19% predicted prevalence of PE in this cohort according to data from the Prospective . . . [Full Text of this Article]

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