Clinical Characteristics of Patients with Peripheral Pulmonary Embolism

Abstract

Background: The clinical relevance of emboli limited to the segmental or sub-segmental pulmonary arteries and the role of anticoagulation in patients with these conditions remains to be clarified. Objectives: To determine the clinical characteristics and treatment outcomes of peripheral pulmonary embolism (PE), and in particular, isolated sub-segmental PE (ISSPE). Methods: We reviewed the data for 334 patients who were diagnosed with a PE by computed tomographic (CT) pulmonary angiography and indirect CT venography. Results: All patients were classified into one of three groups: central (245 patients, 73.4%); segmental (67 patients, 20.1%), and sub-segmental (22 patients, 6.6%). An incidental CT finding (63.6%) was the most common presentation in the segmental and sub-segmental groups. Compared with the central group, the sub-segmental group had less frequent proximal deep venous thrombosis (14 vs. 47%, Bonferroni’s corrected p = 0.002), and greater preservation of oxygenation levels (p < 0.05) without hemodynamic instability. The recurrence of PE and deaths related to PE did not occur in the sub-segmental group, although approximately 30% of the patients did not receive anticoagulation therapy. Conclusions: Patients with ISSPE may have a more benign clinical presentation, as compared to the central type, and may follow a good clinical course without mortality or recurrence.

Symptoms, location and prognosis of pulmonary embolism

“…5 No significant gender difference was found in terms of the extent of the disease; however, the proportion of women is slightly higher in our sample. The age of patients with subsegmental PE was lower than that of patients with central and segmental PE.…”

“…2 It usually has low mortality 2,27 and a good prognosis. 5,28 Thus, a number of authors have suggested that certain patients would not require anticoagulant therapy. 29,30 Our data suggest that patients with subsegmental PE clinically differ to a large degree from those with more proximal PE.…”

“…In a recent study, overall mortality was 8.65% at three months. 4 Central arteries are most commonly involved, 5,6 while subsegmental PE accounts for 4---7% cases. 7---9 However, a number of studies report subsegmental involvement in up to 30% patients.…”

Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years' Clinical Experience

“…This difference was statistically significant. However, it might be related to the clinical severity of the SC LMWH plus thrombolytics group, a longer period of immobilization or concomitant disorders [19]. The ICOPER reported that the mortality rate due to recurrence was 33.7% at day 14 and recurrent PE was detected within 90 days in 12.6 and 7.6%, respectively, in patients with massive versus nonmassive PE [13].…”

Clinical Characteristics and Outcomes of Patients with Clinically Unsuspected Pulmonary Embolism versus Patients with Clinically Suspected Pulmonary Embolism

“…The incidence of UPE has been estimated to be in the range of 0.5–5.7% of chest CT scans, depending on the patient population screened: 3.4–5.7% in unselected CT scans [3,4] and 2.6–4% of cancer patients undergoing staging CT scans for malignancy [5,6,7]. Incidental detection of PE on chest CT is especially common in peripheral, subsegmental emboli [8]. While the existence of UPE is well recognized, only limited information exists regarding the clinical characteristics of these patients, especially the prevalence of comorbidities, clinical presentation and whether they are asymptomatic or merely unsuspected, and the prognostic implications of this condition [9].…”