How I treat: incidental pulmonary embolism.
Blood. 2014 Dec 22;
Authors: O'Connell C
Abstract
The identification of pulmonary embolism (PE) on computed tomography (CT) scans performed for indications other than identification of thromboembolism is a growing clinical problem that has not been adequately addressed by prospective treatment trials. The prevalence of incidentally detected PE ranges from 1-4% in unselected populations, with higher rates among hospital inpatients and patients with cancer. Current guidelines recommend using the same approach to type and duration of anticoagulation as is used for patients with suspected PE. Available data regarding the significance of symptomatic subsegemental PE (SSPE) are conflicting, making it difficult to draw conclusions about the appropriate treatment for incidentally detected SSPE, for which the data are sparse. Among cancer patients the bulk of available data suggests that incidental SSPE (ISSPE) is associated with recurrent venous thromboembolism (VTE) and, when symptomatic, may adversely impact survival. Here, the topic is reviewed utilizing three clinical cases, each of which is followed by a discussion of salient features and then by treatment recommendations.
PMID: 25533036 [PubMed - as supplied by publisher]