title: Unsuspected pulmonary embolism:  impact on mortality among cancer patients.
abstract: OBJECTIVE
  Symptomatic pulmonary embolism is associated with significant morbidity and mortality, but whether the same is true of unsuspected pulmonary embolism (UPE) has only recently become the subject of clinical research. Interest in the impact of UPE on patient outcomes has emerged, as their detection has become more common with the standard use of multirow detector computed tomography scans. Serial CT scanning of patients with cancer, in conjunction with a higher incidence of venous thromboembolism, makes UPE the most frequent in this population. This review will explore the recent studies which evaluate the impact of UPE on outcomes, especially mortality, among patients with cancer.
  
  
  RESULTS
  Several recent studies have attempted to explore the impact that UPE has on cancer patients, mainly with respect to mortality. These studies have all been retrospective and most have used as a comparator cancer patients with suspected pulmonary embolism based on suggestive symptoms. Regardless, the findings in all but one study conclude that UPE adversely impacts survival among cancer patients, even with proper anticoagulation. However, unsuspected subsegmental pulmonary embolism may not impact survival, regardless of the treatment.
  
  
  CONCLUSIONS
  Recent data suggest that cancer patients who develop UPE have mortality rates as well as bleeding rates that parallel those of cancer patients in whom pulmonary embolism is detected on dedicated scans performed because of the presence of pulmonary embolism-related symptoms. Cancer patients who are truly asymptomatic, based on careful screening, may have improved survival, although no prospective studies support definitive treatment recommendations for this group.
authors: Department of Internal Medicine, LAC and USC Medical Center, Keck School of Medicine of USC, Los Angeles, California 90033, USA.
authors: Caroline
authors: C
authors: Piatek
authors: Casey
authors: C
authors: O'Connell
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants