Unsuspected pulmonary emboli in cancer patients: clinical correlates and relevance.
OBJECTIVE
Advances in computed tomography (CT) scanning have led to the detection of unsuspected pulmonary emboli (PE) on routine cancer staging scans. We hypothesized that these patients had signs or symptoms suggestive of PE that may have been overlooked by their health care providers.


METHODS
A retrospective chart review was performed on 59 patients found on routine cancer staging CT scans to have unsuspected PE. Information on patient demographics, malignancy characteristics, risk factors for venous thromboembolism (VTE), and symptoms was recorded. A retrospective case-control analysis was then performed using two age- and stage-matched control patients for each patient who had similar staging CT scans performed during the same period.


RESULTS
Fifty-two patients with unsuspected PE were identified. Forty-four percent had signs or symptoms commonly associated with PE; when fatigue was included, 75% were symptomatic. Ninety-two control patients were identified for 46 of the case patients. Patients with unsuspected PE were significantly more likely to have had a prior history of VTE (20% v 3%; P = .007). The patients with PE were significantly more likely than control patients to complain of fatigue (54% v 20%; P = .0002) and shortness of breath (22% v 8%; P = .02). There was no difference between the groups in administration of chemotherapy within 30 days, central venous catheter use, or erythropoietin therapy.


CONCLUSIONS
Seventy-five percent of patients found to have unsuspected PE on cancer staging CT scans were symptomatic. Fatigue and shortness of breath were significantly more common in patients with unsuspected PE than in control patients.
O'Connell
Casey L
CL
Division of Hematology, Department of Medicine, University of Southern California-Keck School of Medicine, Los Angeles, CA, USA. liebman@hsc.usc.edu
Boswell
William D
WD
Duddalwar
Vinay
V
Caton
Amy
A
Mark
Lisa S
LS
Vigen
Cheryl
C
Liebman
Howard A
HA
D000368:Aged; D016022:Case-Control Studies; D004417:Dyspnea / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed