Unsuspected pulmonary emboli in oncology patients undergoing routine computed tomography imaging.
BACKGROUND
Clinically unsuspected pulmonary embolism (PE) can be detected in oncology patients undergoing computed tomography (CT) imaging for reasons other than for PE diagnosis, but there is little prospective data on its true prevalence, clinical importance, or on methods to improve detection.


METHODS
In consecutive oncology patients undergoing CT imaging of the chest for indications other than PE detection, CT pulmonary angiography (CTPA) was systematically included as part of the imaging protocol. Each imaging study was prospectively analyzed for the presence of PE. A 6-month follow-up was performed. Institutional review board approval was obtained.


RESULTS
Four hundred seven oncology patients were included. Indications for chest CT imaging included baseline staging (31%), restaging after therapy (53%), routine surveillance (15%), or assessment of extrathoracic disease (1%). Clinically unsuspected PE were detected in 18 patients (4.4%). The prevalence of unsuspected PE was 6.4% among inpatients and 3.4% among outpatients. PE was more prevalent among patients with metastatic disease (7% versus 2%, p = 0.007) and in patients who had received recent chemotherapy (11% versus 3%, p = 0.008). In 7 (39%) of the 18 patients with clinically unsuspected PE, emboli were only identifiable on the CTPA study and not on the routine chest CT study. The diagnosis of PE led to immediate changes in patient management.


CONCLUSIONS
Clinically unsuspected PE is present in up to 4.4% of oncology patients undergoing CT imaging for indications other than PE diagnosis. Modifying standard CT imaging protocols to include a CTPA examination optimizes their detection and leads to changes in patient management.
Browne
Ann Michelle
AM
Department of Radiology, University College Hospital, Galway, Ireland. michelleannbrowne@gmail.com
Cronin
Carmel Geraldine
CG
English
Collette
C
NiMhuircheartaigh
Jennifer
J
Murphy
Joseph M
JM
Bruzzi
John F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging*; D015995:Prevalence; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants