Pulmonary tumor embolism: a critical review of clinical, imaging, and hemodynamic features.
Pulmonary tumor embolism is a common finding at autopsy but is generally perceived as a difficult diagnosis to make ante mortem. After a retrospective review of 164 reported cases of pulmonary tumor embolism, we identified a typical profile of clinical, laboratory, and imaging features that may permit confident clinical diagnosis in most patients with this condition. The clinical features include a documented or suspected underlying malignancy, acute to subacute onset of dyspnea, and signs of cor pulmonale. Supportive laboratory features are hypoxemia or increased alveolar-arterial oxygen gradient, and invasive or noninvasive evidence of pulmonary artery hypertension. Typical imaging findings are normal chest radiographs; multiple, subsegmental, peripheral perfusion defects on ventilation-perfusion lung scans; and delayed filling with or without subsegmental filling defects but without a thrombus on pulmonary angiogram. Radiolabeled monoclonal antibody imaging and pulmonary microvascular cytology sampling techniques are promising diagnostic tests for early diagnosis of pulmonary tumor embolism.
Chan
C K
CK
Medical Research Council of Canada, Toronto.
Hutcheon
M A
MA
Hyland
R H
RH
Smith
G J
GJ
Patterson
B J
BJ
Matthay
R A
RA
D000328:Adult; D000911:Antibodies, Monoclonal; D003952:Diagnostic Imaging; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000098:blood supply; D008175:Lung Neoplasms / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating
D000911:Antibodies, Monoclonal