Incidentally found pulmonary embolism: what's the clinician to do?

Incidental pulmonary embolism (IPE) is a management challenge for the unsuspecting clinician. Patients with IPE frequently have signs or symptoms that are unrecognized as PE related, and their clots occur predominantly in the proximal pulmonary vasculature. There is uniformity in recommending anticoagulation for patients with IPE proximal to the subsegmental pulmonary vasculature, but prospective data are not currently available to guide the duration of therapy in this population. Several studies suggest that outcomes, including recurrence, mortality, and bleeding, are similar for patients with IPE and suspected PE, especially among those who also have cancer. Patients with isolated incidental subsegmental pulmonary embolism (ISSPE) are particularly challenging because some studies suggest that they can be managed without anticoagulation. Therefore, an algorithm is proposed to guide the evaluation and treatment of patients with ISSPE.