Clinically unsuspected pulmonary embolism—an important secondary finding in oncology CT

Sebastian, A.J.; Paddon, A.J.

doi:10.1016/j.crad.2005.09.002

Cited by 76 publications

(45 citation statements)

References 12 publications

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“…Moreover, patients with malignancy are not only at increased risk of developing PE, but also of dying from acute PE [13,27]. In our series, according to most studies, and consistent with the most recent American College of Chest Physicians guidelines, a PE diagnosis resulted in modification of therapeutic management in all patients [7,14,15,17,26,[28][29][30]. In fact, regardless of the location and degree of PE detected, the oncologists of our hospital have decided to treat all PE-positive patients with anticoagulation therapy.…”

Section: Discussionsupporting

confidence: 64%

Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

et al. 2015

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Objectives To prospectively assess prevalence/characteristics of clinically unsuspected pulmonary embolism (PE) in cancer patients undergoing follow-up chest MDCT and investigate MDCT protocol. Methods We evaluated 1013 oncologic patients. MDCT images at 5 and 1.25 mm thickness were independently evaluated. Pulmonary artery opacification degree was assessed. Presence, level, and site of PE were reported. Type of malignancy and metastases were reported for PE-positive patients. Results After excluding 1.4 % (14/1013) of examinations due to inadequate vessel opacification, 999 patients (572 male; mean age:68±12 years; range:26-93 years) entered the study. Prevalence of PE was 5 %. There was significant improvement in the sensitivity for both readers in the evaluation of 1.25 mm compared to 5 mm images (46-50 % to 82-92 %). 30 % (15/51) PE were not described by the radiologist in the prospectively issued report; 53 % (27/51) of PE were segmental, 72.5 % (37/51) unilateral. The right lower lobe was the most involved (59 %). 27 % patients had colon cancer, 18 % lung cancer. Among PE-positive patients (25 male; mean age 70±10 years; range:44-87 years), 25 % (13/51) had lung cancer, 15 % (8/51) colon cancer. Conclusions Thin reconstructions are essential for PE diagnosis, regardless of reader experience. Regarding oncologic patients, incidental PE diagnosis influences anticoagulation therapy. Key Points • CT pulmonary angiography is the gold standard for PE diagnosis. • Cancer and oncological treatments are risk factors for PE. • The prevalence of unsuspected PE was 5 %. • Thin reconstructions are essential for PE diagnosis regardless of reader experience. • In oncologic patients, PE diagnosis influences anticoagulation therapy.

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Section: Discussionsupporting

confidence: 64%

Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

et al. 2015

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“…None of the findings in ancillary tests, including ECG and chest X-ray, were significantly different between the study groups, which is consistent with their known low sensitivity and specificity in the diagnosis of PE [5,6,9,16,17,18,19,20,21,22]. …”

Section: Discussionsupporting

confidence: 64%

“…The growing utilization of multidetector computerized tomography (CT) is leading to a change in the trends of PE diagnosis, with a higher rate of detection of unsuspected PE (UPE) [2]. 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].…”

Section: Introductionmentioning

confidence: 99%

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

Shteinberg¹,

Segal-Trabelsy

Adir³

et al. 2012

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Background: The routine use of multidetector computed tomography has led to increased detection of unsuspected pulmonary embolism (UPE), with questionable benefit for diagnosis and treatment. Objective: The purpose of this work was to compare the clinical characteristics and prognosis of patients with UPE to patients with suspected PE (SPE). Methods: We retrospectively reviewed the charts of patients diagnosed with PE in a community-based university hospital between the years 2002 and 2007. UPE was defined as PE detected on CT scans performed for indications other than suspicion of PE. We compared patients with UPE to patients with SPE for differences in clinical features, electrocardiogram, imaging and echocardiographic findings. We also assessed the long-term outcomes using electronic patient records. Results: Of 500 patients with PE, 408 had SPE and 92 had UPE. Patients with UPE were similar to patients with SPE regarding age and sex distribution. Malignancy was more prevalent in UPE patients (39 vs. 23%, p < 0.0068). UPE patients had significantly less tachypnea (37 vs. 57%, p = 0.0005), dyspnea (47 vs. 87%, p < 0.0001), chest pain (19 vs. 42%, p < 0.0001) and hypoxemia (36 vs. 55%, p = 0.0011). Mortality was higher in UPE patients (70.3 vs. 53%, p = 0.0029). The hazard ratio after adjustment for confounders including age, sex and malignancy was 1.546 (95% CI: 1.139–2.099, p = 0.0052). Conclusions: We suggest that UPE is more prevalent in patients with a malignancy and is associated with higher mortality despite a less severe clinical presentation. UPE may be a marker of poor prognosis.

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“…A large population-based, case-control study [10] recently demonstrated that patients with hematologic malignancies had the highest risk of VTE, followed by patients with lung and gastrointestinal cancers. Furthermore, advances in computed tomography (CT), including the introduction of a multidetector row CT, have enhanced the frequency of detection of unsuspected pulmonary emboli in cancer patients [11,12,13]. Despite these facts, the clinical features and prognosis of pulmonary embolism (PE) in lung cancer patients have rarely been reported [3].…”

Section: Introductionmentioning

confidence: 99%

Clinical Course of Pulmonary Embolism in Lung Cancer Patients

et al. 2008

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Background: Although lung cancer is the most common malignancy diagnosed in patients with venous thromboembolism (VTE), data regarding pulmonary embolism (PE) in lung cancer patients are limited. Objectives: To investigate the clinicoradiological features, clinical course and survival of lung cancer patients with PE. Methods: We performed a retrospective case-control study investigating the clinical course and survival of 40 lung cancer patients with PE (PE group). The control group (non-PE group) consisted of 80 lung cancer patients without VTE, treated during the same period. Results: Adenocarcinoma (45.0%, n = 18) was the most common histological type of lung cancer and when PE was diagnosed, the majority of the lung cancer patients were in stages IIIB (37.5%, n = 15) and IV (47.5%, n = 19). Thirty-four patients (85.0%) were diagnosed with PE within 12 months of the diagnosis of lung cancer. The median survival from the diagnosis of PE was 3.5 months in the PE group, but the survival rates revealed no significant difference between the two groups (p = 0.249). In both groups, the most common cause of death was lung cancer progression (76.9 and 80.3%, respectively), followed by chemotherapy-related septic shock (19.2 and 16.7%, respectively). Conclusions: In lung cancer patients, PE may not be the main cause of death, but one of the various complications of lung cancer, despite suggesting a poor prognosis.

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Clinically unsuspected pulmonary embolism—an important secondary finding in oncology CT

Cited by 76 publications

References 12 publications

Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

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

Clinical Course of Pulmonary Embolism in Lung Cancer Patients

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