title: Should we look for silent pulmonary embolism in patients with deep venous thrombosis?
abstract: BACKGROUND
  Asymptomatic or silent pulmonary embolism (S-PE) in patients with deep vein thrombosis has been the focus of numerous publications with the objective of determining the incidence of S-PE and assessing whether its existence has any clinical or therapeutic consequences that outweigh the risks associated with the diagnostic tests performed and the increased healthcare costs. The objectives were to assess the incidence of S-PE using computed tomography angiogram (CTA), to understand the epidemiological factors that might trigger embolism, and to assess whether D-dimer (DD) predicts the existence of S-PE's.
  
  
  METHODS
  A prospective and consecutive assessment of 103 hospitalized patients with lower limb DVT in the absence of PE symptoms, using CT scan. DD was quantified before anticoagulation. The risk factors and characteristics of the DVT were studied. A three-year follow-up assessing risk recurrence and clinical outcome was performed.
  
  
  RESULTS
  The incidence of S-PE was 66%. In 77% of these cases, the main and lobar pulmonary arteries were affected. Iliac and femoral DVTs most often produced S-PE. ROC curve with a DD value higher than 578 ng/ml provided good sensitivity but low specificity to identify patients with S-PE. Diagnosis entailed higher hospitalization expenses. No significant recurrence rate of thrombotic events was observed in the S-PE group during the follow-up.
  
  
  CONCLUSIONS
  The incidence of S-PE in lower-limb DVT is high, but in the absence of symptoms, diagnosis does not appear to be necessary, as there are no short- or long-term clinical or therapeutic consequences.
authors.affiliation: Internal Medicine, Hospital Clínico Universitario, Valencia, Spain. garciafuster_mjo@gva.es.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: García-Fuster
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Fabia
authors.forename: Elena
authors.initials: E
authors.lastname: Furió
authors.forename: Gernot
authors.initials: G
authors.lastname: Pichler
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Forner
authors.forename: Fernando
authors.initials: F
authors.lastname: Martínez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D011859:Radiography; D020246:Venous Thrombosis / Q000097:blood / Q000150:complications*; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D