Outcome of incidentally diagnosed pulmonary embolism in patients with malignancy

With improvements in the quality of computed tomography (CT) examinations, pulmonary embolism is increasingly being detected incidentally in oncology patients undergoing routine cancer staging CT scans. The purpose of this review is to update current evidence on the prognosis of cancer patients diagnosed with incidental pulmonary embolism.

Several recent observational studies have shed some light on the prognostic implications of diagnosing incidental pulmonary embolism in cancer patients. In general, anticoagulant treatment is initiated in these patients. Even during treatment, recurrent venous thromboembolic events may occur with a frequency that is comparable to cancer patients who have symptomatic pulmonary embolism. It has been demonstrated that the diagnosis of incidental pulmonary embolism is associated with adverse survival in cancer patients, and the long-term mortality rate in incidental pulmonary embolism patients seems to approach that of symptomatic pulmonary embolism patients.

Overall, the body of literature on patients with incidental pulmonary embolism is sparse and does not allow firm recommendations on the therapeutic approach to these patients. Yet, in the absence of data on the natural clinical course of these patients, and the presence of cohort studies suggesting that incidental pulmonary embolism may impact recurrent venous thromboembolism and mortality, current consensus is to treat these patients in the same manner as symptomatic patients.