Management of the Incidental Pulmonary Embolism

Chiu, Victor; O’Connell, Casey L.

doi:10.2214/ajr.16.17201

Cited by 21 publications

(12 citation statements)

References 49 publications

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“…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).…”

Section: Discussioncontrasting

confidence: 57%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Lee¹,

Park²,

Kim³

et al. 2018

Radiology

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Purpose To measure the diagnostic yield and false-referral rate (FRR) of staging contrast material-enhanced chest CT based on the clinical stage from contrast-enhanced abdominal CT in patients with colon cancer. Materials and Methods This retrospective study included 1743 patients (mean age, 63.4 years; range, 18-96 years) with a diagnosis of colon cancer. The primary outcomes were diagnostic yield and FRR of contrast-enhanced chest CT in the detection of thoracic metastasis. The proportions of patients with occult thoracic metastasis and those undergoing pulmonary metastasectomy for true-positive metastases were key secondary outcomes. The outcomes were stratified according to clinical stage at contrast-enhanced abdominal CT. Results The diagnostic yields in clinical stage 0/I, cII, cIII, and cIV were 0% (95% confidence interval [CI]: 0%, 0.8%), 1.3% (95% CI: 0.4%, 3.3%), 4.4% (95% CI: 3.0%, 6.1%), and 43.3% (95% CI: 36.8%, 49.9%), respectively. The corresponding FRRs were 5.7% (95% CI: 3.8%, 8.2%), 2.9% (95% CI: 1.3%, 5.5%), 6.7% (95% CI: 5.0%, 8.8%), and 6.1% (95% CI: 3.4%, 10.0%), respectively. The proportions of patients with occult metastasis were 0% (95% CI: 0%, 0.8%), 3.3% (95% CI: 1.6%, 5.9%), 1.5% (95% CI: 0.8%, 2.7%), and 6.1% (95% CI: 3.4%, 10.0%), respectively. The proportion of patients who underwent pulmonary metastasectomy was 0% (none of 474; 95% CI: 0%, 0.8%) for clinical stage 0/I tumors. Conclusion In clinical stages 0 and I, the diagnostic yield of staging contrast-enhanced chest CT in detecting thoracic metastasis was zero. For clinical stages II, III, and IV, contrast-enhanced chest CT as a baseline examination was helpful for the detection of thoracic metastasis and allowed for the possibility of a curative metastasectomy. There was no significant association between clinical stage and false-referral rate. © RSNA, 2018 Online supplemental material is available for this article.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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

Lee¹,

Park²,

Kim³

et al. 2018

Radiology

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“…28,29 The management of incidentally discovered or silent PE in patients without known VTE risk factors is controversial, as large prospective studies have not yet shown benefits of anticoagulation in these cases. 30…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism and Sigmoid Sinus Thrombosis After Translabyrinthine Vestibular Schwannoma Resection: A Retrospective Case Series

Song

Ayoub

Chen

et al. 2021

Ann Otol Rhinol Laryngol

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Objective: To describe the presentation and treatment of patients developing pulmonary embolism following translabyrinthine approach for vestibular schwannoma resection. Methods: This was a retrospective case series of patients at 2 academic tertiary medical centers who developed symptomatic pulmonary embolism post-operatively following translabyrinthine approach for vestibular schwannoma resection and were found to have evidence of sigmoid sinus thrombosis. Results: Three patients were identified to have post-operative pulmonary emboli after translabyrinthine approach for vestibular schwannoma resection with sigmoid sinus or internal jugular vein clots in the absence of lower extremity deep vein thrombosis. Caprini scores for these patients were 5 or lower. All patients underwent CT pulmonary angiography and were confirmed to have pulmonary emboli. Two were promptly anticoagulated with heparin drips and transitioned to long-term oral anticoagulation therapy and 1 had delayed anticoagulation. None of these patients suffered from intracranial hemorrhage post-operatively. Conclusions: Patients undergoing translabyrinthine approach for vestibular schwannoma can develop pulmonary embolism from sigmoid sinus entry or thrombosis. No clear guidelines exist for the management of this complication in the setting of recent craniotomy and the risk of intracranial hemorrhage must be considered prior to initiating anticoagulation.

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“…Management is uncertain due to a lack of high quality evidence. Anticoagulation is recommended if the patient has symptoms that could be attributable to the PE; the PE is located in the main, lobar and/or segmental pulmonary arteries; concurrent DVT is present; or the patient has active cancer . Anticoagulation may not be necessary if the patient has a single subsegmental PE and no additional VTE risk factors …”

Section: Unresolved Issuesmentioning

confidence: 99%

Pulmonary embolism: update on diagnosis and management

Krüger

Eikelboom

Douketis

et al. 2019

Medical Journal of Australia

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Summary Pulmonary embolism (PE) is a potentially life‐threatening condition, mandating urgent diagnosis and treatment. The symptoms of PE may be non‐specific; diagnosis therefore relies on a clinical assessment and objective diagnostic testing. A clinical decision rule can determine the pre‐test probability of PE. If PE is “unlikely”, refer for a D‐dimer test. If the D‐dimer result is normal, PE can be excluded. If D‐dimer levels are increased, refer for chest imaging. If PE is “likely”, refer for chest imaging. Imaging with computed tomography pulmonary angiogram is accurate and preferred for diagnosing PE, but may detect asymptomatic PE of uncertain clinical significance. Imaging with ventilation–perfusion (VQ) scan is associated with lower radiation exposure than computed tomography pulmonary angiogram, and may be preferred in younger patients and pregnancy. A low probability or high probability VQ scan is helpful for ruling out or confirming PE, respectively; however, an intermediate probability VQ scan requires further investigation. The direct oral anticoagulants have expanded the anticoagulation options for PE. These are the preferred anticoagulant for most patients with PE because they are associated with a lower risk of bleeding, and have the practical advantages of fixed dosage, no need for routine monitoring, and fewer drug interactions compared with vitamin K antagonists. Initial parenteral treatment is required before dabigatran and edoxaban.

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Management of the Incidental Pulmonary Embolism

Abstract: The treatment of subsegmental PE may be guided by an assessment of patient symptoms, risk factors for recurrent venous thrombosis, and concomitant deep venous thrombosis.

Cited by 21 publications

References 49 publications

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

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

Pulmonary Embolism and Sigmoid Sinus Thrombosis After Translabyrinthine Vestibular Schwannoma Resection: A Retrospective Case Series

Pulmonary embolism: update on diagnosis and management

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