Objective: To appraise the evidence on the diagnostic accuracy of CT pulmonary angiography and the prognostic value of a negative CT pulmonary angiogram in the diagnosis of pulmonary embolism. Methods: Medline, EMBASE, and grey literature were systematically searched by two researchers. Any study which compared CT pulmonary angiography to an acceptable reference standard or prospectively followed up a cohort of patients with a normal CT pulmonary angiogram was included. Study methods were appraised independently by two researchers, and data were extracted independently by three researchers. Results: Thirteen diagnostic and 11 follow up studies were identified. Studies varied in prevalence of pulmonary embolism (19-79%), patient groups, and method quality. Few studies recruited unselected emergency department patients. There was heterogeneity in the analysis of sensitivity (53 to 100%), specificity (79 to 100%), and false negative rate (1.0 to 10.7%). The pooled false negative rate of combined negative CT pulmonary angiography and negative deep vein thrombosis testing was 1.5% (95% CI 1.0 to 1.9%). Conclusion: Diagnostic studies give conflicting results for the diagnostic accuracy of CT pulmonary angiography. Follow up studies show that CT pulmonary angiography can be used in combination with investigation for deep vein thrombosis to exclude pulmonary embolism.T he diagnosis of pulmonary embolism is challenging as symptoms of pulmonary embolism are varied and range from mild, non-specific lethargy or breathlessness, to collapse and cardiac arrest.1-3 Recurrent pulmonary embolism is associated with a case mortality of 26%. 4 Early diagnosis is essential as even patients with minor symptoms are at risk of recurrent pulmonary emboli.The combination of a normal D-dimer concentration and low clinical probability score 5-7 provides a robust screening method, facilitating exclusion of pulmonary embolism without diagnostic imaging. The PIOPED study 8 proposed combining ventilation-perfusion scanning with clinical probability for the safe exclusion and diagnosis in a subset of patients. This strategy does not exclude or diagnose pulmonary embolism in all suspected cases. The gold standard investigation-pulmonary angiography-is invasive and carries a recognised morbidity and mortality. Furthermore, a normal angiogram is associated with a 1.6% incidence of venous thromboembolism in the following year. 10Computed tomographic pulmonary angiography (CT pulmonary angiography) is increasingly used in the diagnosis of pulmonary embolism. CT has the advantage of imaging the entire thorax, facilitating the diagnosis of conditions mistaken for pulmonary embolism, such as pneumonia, aortic dissection, and malignancy.11 UK and US guidelines have planted CT among the basic investigations for pulmonary embolism.12 13 Attempts to evaluate the clinical utility of CT pulmonary angiography have been complicated by rapid advances in CT scanning technology, acceptance that angiography may not be the most appropriate reference standard, and he...

We report a case of a low-birth-weight infant with an infection of the urinary tract with Trichomonas vaginalis, who later developed cystic chronic lung disease suggestive of Wilson-Mikity syndrome. Although she had mild respiratory distress syndrome at birth, the extent of the chronic lung disease was out of proportion to the initial illness. We speculate that maternal infection with this organism may have resulted in an inflammatory response that led to its development.

Coagulase-negative staphylococci (CoNS) are often dismissed as a contaminant of blood cultures and are rarely considered as an etiology of perinatally acquired infections. We describe a case of early-onset sepsis with Staphylococcus auricularis in an extremely low-birth weight infant.

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Atraumatic clostridial myonecrosis is a rare but potentially life-threatening infective condition which is thought to occur in elderly and immunocompromised subjects via bacterial translocation through the gut wall and distant haematological seeding. Previous case reports have mainly focused on an association with malignancy and bowel inflammation. The case is reported of an 84-year-old woman initially treated for cardiac chest pain, with a medical history comprising only of type 2 diabetes, hypertension and monoclonal gammopathy of unknown significance. Chest pain remains a common presentation to all emergency departments worldwide and, with increasing pressure for early intervention in cardiac causes, prehospital treatment is becoming more commonplace. Clinicians must be sure to make a thorough initial assessment and take care when prescribing cardiac medications for chest pain, owing to the vast spectrum of differential diagnoses.