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Implications of unsuspected pulmonary embolism detected by computed tomography
W M Romano1, P N Cascade, M T Korobkin
1Department of Radiology, St. Joseph's Health Centre, London, Ont.
Insights
Incidental findings of pulmonary thromboembolism on computed tomography (CT) scans require careful radiologist attention. Prompt diagnosis of these occult pulmonary emboli can lead to timely treatment, reducing associated morbidity and mortality.
Area of Science:
- Radiology
- Pulmonary Medicine
- Cardiovascular Imaging
Background:
- Pulmonary thromboembolism (PTE) is a significant cause of morbidity and mortality.
- Computed tomography (CT) is frequently used for thoracic imaging, often revealing incidental findings.
- Occult PTE may be missed on routine CT interpretation.
Purpose of the Study:
- To describe the computed tomography (CT) findings of incidentally discovered pulmonary thromboembolism.
- To evaluate the clinical implications and impact on patient management of these incidental findings.
Main Methods:
- Retrospective review of CT studies and medical records for nine patients with unsuspected PTE.
- Analysis of emboli location, associated parenchymal/pleural abnormalities, and subsequent patient care changes.
- Patients ranged from 51-75 years, with emboli identified in pulmonary artery zones 1, 2, and 3.
Main Results:
- Four patients had infarcts, and three had pleural effusions.
- Eight patients underwent confirmatory testing for PTE.
- Management included vena cava filters (3 patients) and anticoagulation therapy (all patients), with all patients surviving.
Conclusions:
- Radiologists must be vigilant for occult pulmonary thromboembolism during thoracic CT interpretation.
- Diagnosing incidental PTE can lead to immediate treatment modifications.
- Early detection and management of PTE can potentially decrease associated morbidity and mortality.
Objective:
To describe the computed tomography (CT) findings and clinical implications of pulmonary thromboembolism noted incidentally on CT.
Patients And Methods:
The authors reviewed the CT studies and medical records for nine patients in whom CT had shown clinically unsuspected pulmonary thromboembolism. The study group consisted of seven men and two women ranging in age from 51 to 75 years, who were referred for CT over a 5-year period for a variety of indications. The location of the emboli and the presence and location of parenchymal and pleural abnormalities were determined. Subsequent changes in patient care were analysed.
Results:
The locations of the thromboemboli were described according to pulmonary zone. One case involved zone 1 (main pulmonary artery to a lung), all involved zone 2 (first-order branches), and four involved extension into zone 3 (second-order branches). No emboli were distinguished in zone 4 (beyond the segmental arteries). Four patients had pleural-based opacities characteristic of infarcts, and three had pleural effusions. Eight patients underwent confirmatory testing. A vena cava filter was placed in three patients, one of whom also received anticoagulation therapy. The other six patients were treated by anticoagulation alone. All of the patients survived and were discharged.
Conclusion:
Radiologists should watch carefully for occult pulmonary thromboembolism when interpreting CT studies of the thorax. Establishing this diagnosis can result in immediate changes to treatment and possibly a reduction in the substantial morbidity and mortality associated with untreated pulmonary emboli.