title: The clinician's response to a report of an incidental pulmonary embolism detected on multidetector CT.
abstract: BACKGROUND
  The prevalence of incidental pulmonary emboli (PE) detected on contrast enhanced CT performed for other reasons is approximately 2.5%. The treatment decisions based upon the discovery of incidental PE have been less well reported. The purpose of this study was to report the clinician's response to, and consequences of, the finding of incidental PE on contrast enhanced CT.
  
  
  METHODS
  Retrospective cohort study. Patients with incidental PE detected on a contrast enhanced CT were retrospectively identified at a single institution between 1 January 2009 and 31 December 2009. Case note review was performed to assess clinicians' responses to this finding. Patients with synchronous venous thromboembolism, unrecognised symptoms or factors preventing response assessment were excluded from this analysis. Patient and PE characteristics, treatment, and outcomes related to treatment and non-treatment were recorded.
  
  
  RESULTS
  There were 73 patients with incidental PE: 52 were in the proximal pulmonary arteries and 21 were distal. 16 patients were excluded from the treatment analysis. 52 of 57 (91.2%) patients were treated with therapeutic anticoagulation. There were 2 (3.8%) serious adverse events related to treatment. 5 (8.8%) patients were not treated; 2 (40%) developed recurrent venous thromboembolism. Treatment of incidental PE was not significantly associated with patient age, PE risk factors or PE location. A smaller proportion of single incidental PE were treated than multiple incidental PE (p=0.047).
  
  
  CONCLUSIONS
  There is morbidity associated with both treatment and non-treatment of incidental PE. However, despite the uncertainty about the natural history and clinical significance of incidental PE, the majority of patients at the authors' institution received prompt anticoagulation.
authors.affiliation: Department of Radiology, Churchill Hospital, Oxford, UK. james.franklin@nds.ox.ac.uk
authors.forename: James M
authors.initials: JM
authors.lastname: Franklin
authors.forename: Najib
authors.initials: N
authors.lastname: Rahman
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Gleeson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D006113:United Kingdom
chemical_list: D000925:Anticoagulants