Prevalence and significance of asymptomatic venous thromboembolic disease found on oncologic staging CT.
OBJECTIVE
The purpose of our study was to determine the prevalence of unsuspected venous thromboembolic disease--specifically, of pulmonary embolism (PE) and of inferior vena cava (IVC), iliac, and iliofemoral deep venous thromboses (DVTs)--in oncology patients on staging CT scans of the thorax, abdomen, and pelvis.


METHODS
Retrospective analysis was performed on 435 consecutive staging CT thorax, abdomen, and pelvis scans performed on a variety of oncology patients for the presence of venous thromboembolic disease. The patient group consisted of 198 men and 237 women who ranged in age from 20 to 79 years (mean, 55 years). Disease type, stage, concomitant surgery or chemoradiation therapy regimes, anticoagulation status, and 6-month clinical and radiologic follow-up findings were recorded.


RESULTS
We found a prevalence of 6.8% (23/339) unsuspected iliofemoral, 1.2% (4/339) unsuspected common iliac, and 0.3% (1/315) unsuspected IVC DVTs and 3.3% (13/397) unsuspected PEs occurring in patients with a wide range of malignancies. The overall prevalence of unsuspected venous thromboembolism (i.e., DVT, PE, or both) was 6.3% (25/397). DVT, PE, and venous thromboembolic disease were more common in inpatients (p = 0.002, 0.004, 0.023; relative risk [RR] = 1.6, 2.1, 1.4, respectively) and in those with advanced disease (p = 0.001, 0.01, 0.001; RR = 2.2, 1.8, 2.0, respectively).


CONCLUSIONS
Although there is a known increased risk of thromboembolism (DVT and PE) in oncology patients, many cases are not diagnosed, which can prove fatal. Staging CT simultaneously affords one sole investigation of the pulmonary, IVC, iliac, and upper femoral veins, thereby providing an important diagnostic opportunity. Assessment for DVT and PE is important when reviewing staging CT scans.
Cronin
Carmel G
CG
Department of Radiology, University College Hospital, Newcastle Rd., Galway, Ireland. carmelcronin2000@hotmail.com
Lohan
Derek G
DG
Keane
Maccon
M
Roche
Clare
C
Murphy
Joseph M
JM
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*