Management of incidental pulmonary embolism

Abstract

Incidental pulmonary embolism (PE) is a frequent finding on routine computed tomography (CT) scans of the chest, occurring in 1.1% of coronary CT scans and 3.6% of oncological CT scans. Despite this high frequency, optimal management of incidental PE has not been addressed in clinical trials and remains the subject of debate. Although these CT scans have not been performed with a dedicated PE protocol and have suboptimal contrast enhancement, diagnosis of incidental PE has been shown to be accurate up to the segmental and subsegmental arteries. The embolic load in incidental PE is lower than that in symptomatic PE. Even so, observational studies suggest that the natural course of incidental PE is similar to that of symptomatic PE with regard to the risk of recurrent venous thrombotic disease and mortality. Interestingly, the increased use of more advanced CT technology has coincided with an increase in the rate of incidental subsegmental PE, as is the case for symptomatic subsegmental PE. Although clinical trials are lacking, and observational data are limited to cancer-associated incidental PE, the consensus is that the management of incidental PE is identical to that of symptomatic PE, including the choice of optimal drug class, outpatient treatment and total duration of treatment.

Diagnostic Yield and False-Referral Rate of Staging Chest CT in Patients with Colon Cancer

“…Because early lung adenocarcinomas manifesting as subsolid nodules are considered to be more common in Asians than in the Occidental population (25), the prevalence of incidentally detected lung cancer among female never-smokers may be smaller in a different ethnic population than in our study patients. The reported frequency of incidental pulmonary embolism has increased over time with the introduction of CT machines (26)(27)(28). The prevalences of symptomatic and asymptomatic pulmonary embolism in our patient population were 0.2% and 0.4%, respectively, lower than the reported prevalence (3.1%-3.6% of patients with malignancy) of incidental pulmonary embolism (27,28).…”

“…The reported frequency of incidental pulmonary embolism has increased over time with the introduction of CT machines (26)(27)(28). The prevalences of symptomatic and asymptomatic pulmonary embolism in our patient population were 0.2% and 0.4%, respectively, lower than the reported prevalence (3.1%-3.6% of patients with malignancy) of incidental pulmonary embolism (27,28). This discrepancy may be explained by different patient characteristics, including patient age, body mass index, race, and malignancy type.…”

Cancer-associated thrombosis: the when, how and why

“…The cancer patient is frequently submitted for chest CT scans for several reasons; from the evaluation of disease progression to potential side-effects of chemotherapy in the lung. Incidental pulmonary embolism is a frequent finding on these CT scans, being found in ∼3.6% of patients [60]. Cancer confers to the patient a higher risk of VTE, and asymptomatic pulmonary embolism may be an indicator of an acquired procoagulant state.…”

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

“…11 The course of incidental VTE and the risk-benefit balance of therapeutic anticoagulation remain to be investigated in the noncancer setting, such as among patients with chronic obstructive pulmonary disease, stroke, coronary artery disease, pulmonary infection, or major trauma or surgery. 12 Despite this, the current guidelines of the American College of Chest Physicians suggest the same initial and long-term anticoagulation strategy in patients with incidental VTE as for patients with symptomatic VTE. 13,14 In the absence of evidence from confirmatory trials, 15 there is need for further data from observational studies to estimate the risk of complications after incidental VTE.…”