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Symptomatic subsegmental pulmonary embolism: what is the next step?
M Carrier1, M Righini, G Le Gal
1Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada. mcarrier@toh.on.ca
Journal of Thrombosis and Haemostasis : JTH
|June 8, 2012
Summary
Computed tomography pulmonary angiography (CTPA) increases diagnoses of subsegmental pulmonary embolism (SSPE). However, SSPE may not require anticoagulant treatment, as evidence suggests it might be clinically unimportant, warranting further study.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Pulmonary Medicine
Background:
- Computed tomography pulmonary angiography (CTPA) has increased pulmonary embolism (PE) diagnoses.
- The clinical significance of subsegmental PE (SSPE) identified by CTPA remains uncertain.
- Inter-observer agreement for SSPE diagnosis on CTPA is notably low.
Purpose of the Study:
- To investigate the clinical importance of subsegmental pulmonary embolism (SSPE) diagnosed via CTPA.
- To determine if SSPE requires anticoagulant therapy.
- To evaluate the correlation between CTPA findings and true SSPE.
Main Methods:
- Review of literature on CTPA, SSPE, and management strategies for PE.
- Analysis of existing cohort studies and case reports regarding SSPE.
- Comparison of CTPA findings with pulmonary angiography and ventilation-perfusion scans.
Main Results:
- CTPA frequently identifies subsegmental filling defects, but their correlation with true SSPE is unclear.
- Low inter-observer agreement exists for SSPE diagnosis on CTPA.
- Small cohorts suggest SSPE without DVT may be safely managed without anticoagulation, with no recurrent VTE observed.
Conclusions:
- Subsegmental pulmonary embolism (SSPE) diagnosed by CTPA may be clinically unimportant and potentially overtreated with anticoagulation.
- Current evidence is hypothesis-generating and requires confirmation through prospective clinical management studies.
- Further research is needed before altering clinical practice regarding SSPE management.
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