Pleuroparenchymal abnormalities in cancer patients undergoing CTPA for suspected pulmonary embolism

To characterize pleuroparenchymal abnormalities identified on computed tomography pulmonary angiography (CTPA) in cancer patients investigated for suspected pulmonary embolism (PE) and to compare imaging findings between patients with and without confirmed PE.

This single-center retrospective observational study included 113 consecutive cancer patients who underwent CTPA for suspected acute PE between January 2022 and January 2026. Radiology reports and electronic medical records were reviewed for demographic data, malignancy type and stage, PE-related imaging characteristics, and pleural and pulmonary parenchymal abnormalities. Imaging findings were compared between PE-positive and PE-negative groups. An exploratory multivariable model with a restricted set of imaging predictors was constructed to limit overfitting, with correction for multiple comparisons and bootstrap-based internal validation. Exploratory subgroup analyses by malignancy type and disease burden were also performed.

PE was confirmed in 32 patients (28.3%). The median age was 59 years (IQR, 51-65), and 42.5% were female. The highest PE prevalence was observed in gastrointestinal, gynecologic, and thoracic malignancies. At nominal testing, infarct-like wedge-shaped opacity was more frequent in PE-positive patients (12.5% vs. 1.2%; OR, 11.43; p = 0.022), whereas ground-glass opacity (15.6% vs. 35.8%; OR, 0.33; p = 0.041) and interstitial/septal change (3.1% vs. 25.9%; OR, 0.09; p = 0.007) were less frequent. None remained statistically significant after false-discovery-rate correction (q = 0.133, 0.166, and 0.082, respectively). The parsimonious model had an apparent AUROC of 0.707 and an optimism-adjusted AUROC of 0.699, with acceptable grouped calibration (Hosmer-Lemeshow p = 0.522). No exploratory cancer-subgroup comparison met q < 0.05.

Pleuroparenchymal abnormalities are highly prevalent in cancer patients undergoing CTPA for suspected PE; however, most findings are nonspecific. Infarct-like wedge-shaped opacity generated the strongest exploratory PE-associated signal, but no individual imaging comparison survived multiplicity correction and model estimates remained imprecise. These findings should therefore be considered hypothesis-generating and require validation in larger cohorts.