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Chijik A, Jerdev M, Dahoud WA, Sela Y, Blum A. RV size may predict death in unstable patients with PE. Ir J Med Sci 2024; 193:671-675. [PMID: 37639161 DOI: 10.1007/s11845-023-03508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Pulmonary emboli (PE) is a life threatening condition that discovered in many patients only "post mortem". Sub massive and massive PE that led to hemodynamic collapse characterized by right ventricular (RV) dysfunction, leading to a higher risk of death. OBJECTIVES To assess the ability to predict in hospital death of patients with acute PE, using a non-gated computed tomography pulmonary angiography (CTPA), based on the dimensions of the right ventricle. METHODS A retrospective study that analyzed CTPA images of patients admitted with acute PE during the years 2012-2017. The cohort study included 300 patients with documented acute PE, among them 255 hospitalized in medical (non-intensive care unit) wards, 45 were hospitalized in an intensive care unit (ICU). RESULTS Among the 45 patients admitted to the ICU 8% died. Larger RV diameters predicted mortality (OR = 10.14, 95% CI [1.09-93.86]) as well as lower systolic and diastolic blood pressure measurements (p = 0.001 and 0.01). Among the 255 patients admitted to the Internal Medicine Ward 7% died. Older age (p = 0.028), sepsis and cancer (both p < 0.001), high WBCs count (p < 0.001), and renal failure (p < 0.001) predicted death. Lower blood pressure (systolic and diastolic) (p < 0.001, 0.008), older age (p < 0.007), sepsis (p < 0.001), cancer (p = 0.006), higher WBCs count (p < 0.001), and impaired renal function (p < 0.001) predicted death in patients admitted with acute PE. CONCLUSIONS Clinical parameters and hematological parameters could predict death of patients admitted with acute PE. RV diameter, measured by the non-ECG gated CTPA, had an additive predictive value for patients who admitted to the ICU.
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Affiliation(s)
| | - Michael Jerdev
- Imaging Department, Tzafon Medical Center, Tiberias, Israel
| | | | - Yaron Sela
- Epidemiology and Statistics, Reichman University, Herzlia, Israel
| | - Arnon Blum
- Department of Medicine, Laniado Hospital, Netanya, Adelson School of Medicine, Ariel University, Ariel, Israel.
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Luo Z, Ma G, Lu Y, Yao J, Xu N, Cao C, Ying K. Characteristics and 6-Month Mortality of Medical Oncology Patients With Incidental and Symptomatic Pulmonary Embolism: A Single-Institutional Retrospective Longitudinal Analysis. Clin Appl Thromb Hemost 2023; 29:10760296231155177. [PMID: 36748784 PMCID: PMC9909045 DOI: 10.1177/10760296231155177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study aimed to identify clinical characteristics of cancer patients with incidental pulmonary embolism (IPE) and assess the variables associated with 30-day mortality in cancer patients with PE including symptomatic pulmonary embolism (SPE) and IPE. 6-Month mortality rate in cancer patients with SPE and IPE were also compared. We retrospectively analyzed electronic medical records of cancer patients with newly diagnosed PE between January 2016 and June 2021. We compared clinical and radiological characteristics in cancer patients with IPE and SPE and identified variables associated with the overall 30-day mortality on multivariate analysis. All patients were followed up for 6 months and survival analysis was performed by use of Kaplan-Meier. Five hundred and nine eligible cancer patients with pulmonary embolism were identified during the study period. IPE is associated with lower BMI, colorectal and pancreas cancers, stage III/IV of cancer, recent antiangiogenic therapy, central venous catheter (CVC) and chronic cardiac or respiratory disease compared to SPE. The factors associated with 30-day mortality included poor performance status, lung/pleura or upper gastrointestinal cancers, stage III/IV of cancer, previous VTE, oxygen saturation < 95%, lactic acid > 2 mmol/l and bilateral PE. The overall survival in patients with IPE at 6-month follow-up was similar to those diagnosed with SPE. The present study has allowed the identification of factors associated with 30-day mortality in cancer patients with IPE and SPE. We also found similar mortality rate in cancer patients with IPE compared with patients with SPE at 6-month follow-up.
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Affiliation(s)
- Zhuanbo Luo
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China,Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guofeng Ma
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yangfei Lu
- Department of Respiratory Disease, Hangzhou Fuyang District First People's Hospital, Hangzhou, Zhejiang, China,Department of Respiratory Disease, Deqing People’s Hospital, Deqing, Zhejiang, China
| | - Jianchang Yao
- Department of Respiratory Disease, Deqing People’s Hospital, Deqing, Zhejiang, China,Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ning Xu
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Chao Cao
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Kejing Ying
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Kejing Ying, Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310020, China.
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Using Routine Chest Computed Tomography to Diagnose Pulmonary Embolism. J Comput Assist Tomogr 2022; 46:888-893. [DOI: 10.1097/rct.0000000000001372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Incidental pulmonary embolism in oncologic patients-a systematic review and meta-analysis. Support Care Cancer 2020; 29:1293-1302. [PMID: 32621266 PMCID: PMC7843533 DOI: 10.1007/s00520-020-05601-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
Purpose Incidental pulmonary embolism (IPE) is a common finding on computed tomography (CT). IPE is frequent in oncologic patients undergoing staging CT. The aim of this analysis was to provide the pooled frequency of IPE and frequencies of IPE in different primary tumors. Methods MEDLINE, SCOPUS, and EMBASE databases were screened for studies investigating frequency of IPE in oncologic staging CT up to February 2020. Overall, 12 studies met the inclusion criteria and were included into the present study. Results The pooled analysis yielded a total of 28,626 patients. IPE was identified in 963 patients (3.36%, 95% CI = 3.15; 3.57). The highest frequency was found in prostate cancer (8.59%, 95%CI = 3.74; 13.44), followed by hepatobiliary carcinoma (6.07%, 95%CI = 3.09; 9.05) and pancreatic cancer (5.65%, 95%CI = 3.54; 7.76). The lowest frequencies were identified in tumors of male reproductive organs (0.79%, 95%CI = 0.21; 1.37) and hematological diseases (1.11% 95%CI = 0.74; 1.48). Conclusion The overall frequency of IPE in oncologic patients was 3.36%. There are considerable differences in regard to primary tumors with the highest frequency in prostate cancer and pancreatic and hepatobiliary carcinomas.
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Tiseo M, Bersanelli M, Barili MP, Bartolotti M, De Luca G, Gelsomino F, Camisa R, Cademartiri F, Ardizzoni A. Asymptomatic Pulmonary Embolism in Lung Cancer: Prevalence and Analysis of Clinical and Radiological Characteristics in 141 Outpatients. TUMORI JOURNAL 2018; 98:594-600. [DOI: 10.1177/030089161209800509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background The incidence of asymptomatic pulmonary embolism in cancer patients is unknown and strictly related to the imaging used for tumor assessment. Recent findings suggest a similar clinical outcome of asymptomatic pulmonary embolism events compared to symptomatic events with a significant impact on survival. The aim of the present study was to determine the prevalence of asymptomatic pulmonary embolism in a population of lung cancer outpatients and to investigate its clinical features. Methods Outpatients with a diagnosis of lung carcinoma undergoing chemotherapy were selected from October 2006 to June 2009. Disease and patient characteristics, risk factors and treatment modalities were collected. All the computed tomography images performed for each patient during the study period were retrospectively reviewed to identify pulmonary embolism. Results A total of 141 consecutive patients were included and 657 computed tomography scans were completely reviewed (from two to six consecutive scans for each patient). Asymptomatic pulmonary embolism in the study population had a prevalence of 14.9% (21 patients). Most of the events occurred in patients with adenocarcinoma, advanced stage and poor performance status, during the early phases of first-line chemotherapy or at the same time of the cancer diagnosis. Compared with the symptomatic pulmonary embolism events (5 patients), asymptomatic events occurred earlier (time from cancer diagnosis to pulmonary embolism of 3.5 [95% CI, 2.0–4.9] versus 12.1 months [95% CI, 6.3–17.9; P = 0.02]) and had a better prognosis (survival from PE of 7.5 [95% CI, 3.4–11.6] versus 1.9 months [95% CI, 0–3.9; P = 0.04]). Conclusions Our findings indicate an underestimation of embolic events among lung cancer outpatients due to their frequent asymptomatic natur. Such a high prevalence suggests the importance to pay more attention to pulmonary embolism prevention in this population.
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Affiliation(s)
- Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | - Marco Bartolotti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giovanni De Luca
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Roberta Camisa
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Andrea Ardizzoni
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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Incidental Pulmonary Embolism After Coronary Artery Bypass Surgery: Long-Term Clinical Follow-Up. AJR Am J Roentgenol 2017; 210:52-57. [PMID: 29064757 DOI: 10.2214/ajr.17.18186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the incidence and natural history of incidentally found and untreated pulmonary embolism (PE) at coronary CT angiography after coronary artery bypass grafting. MATERIALS AND METHODS We retrospectively reviewed the records of 353 patients consecutively registered between January 1, 2010, and November 11, 2015, who underwent coronary artery bypass grafting followed within 2 weeks by coronary CT angiography. All patients received 100 mg of aspirin and 75 mg of clopidogrel after surgery. We collected relevant clinical and CT data, including total follow-up duration after coronary artery bypass grafting, follow-up CT findings, mortality, and incidence of any recurrent PE. RESULTS PE was diagnosed in 22 of the 353 patients (6.2%) who remained in the study after the exclusion criteria were applied. Most of the PEs occurred at the segmental or subsegmental level. All patients were in hemodynamically stable condition, had no symptoms, and underwent follow-up for a median of 53 months (range 19-74 months). Twenty of the 22 patients did not receive anticoagulation, and all but one of these patients had complete resolution of PE at second follow-up coronary CT angiography (median, 149 days after surgery). There was no associated mortality or recurrent PE. CONCLUSION Incidental PE after coronary artery bypass grafting is found in approximately 6% of patients undergoing postoperative coronary CT angiography, and most PEs resolve spontaneously without anticoagulation. No patient in this study died or had recurrent PE during a median follow-up period of 53 months.
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Best Clinical Practice: Current Controversies in Pulmonary Embolism Imaging and Treatment of Subsegmental Thromboembolic Disease. J Emerg Med 2017; 52:184-193. [DOI: 10.1016/j.jemermed.2016.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
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Palla A, Celi A, Marconi L, Pistelli F, Tavanti L, Desideri M, Carrozzi L. Venous Thromboembolism in Cancer: Frequently Asked Questions When Guidelines are Inconclusive. Cancer Invest 2015; 33:142-51. [DOI: 10.3109/07357907.2015.1009631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Clinically unsuspected pulmonary embolism (UPE) is frequently diagnosed in cancer patients undergoing routine computed tomography scans for staging purposes or treatment response evaluation. The reported incidence of UPE ranges from 1% to 5% which probably represents an underestimation. A significant proportion of cancer patients with UPE actually do have pulmonary embolism (PE) related symptoms. However, these can erroneously be attributed to the cancer itself or to cancer therapy leading to a delayed or missed diagnosis. The incidence of UPE is likely to increase further with the improvements of imaging techniques. Radiologic features of UPE appear similar to symptomatic PE with nearly half of the UPE located in central pulmonary arteries and one third involving both lungs. UPE in cancer patients is not a benign condition with rates of recurrent venous thromboembolic events, bleeding and a mortality rate comparable to cancer patients with symptomatic PE. Current guidelines suggest that UPE should receive similar initial and long-term anticoagulant treatment as for symptomatic PE. However, direct evidence regarding the treatment of UPE is scarce and treatment indications are largely derived from studies performed in cancer patients with symptomatic venous thromboembolism. Selected subgroups of cancer patients with UPE such as those with sub-segmental UPE may be treated conservatively by withholding anticoagulation and avoiding the associated bleeding risk, although this requires further evaluation.
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Affiliation(s)
- Nick van Es
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Equal contributors
| | - Suzanne M Bleker
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Equal contributors
| | - Marcello Di Nisio
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy.
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Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JSR, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35:3033-69, 3069a-3069k. [PMID: 25173341 DOI: 10.1093/eurheartj/ehu283] [Citation(s) in RCA: 1830] [Impact Index Per Article: 183.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Shteinberg M, Segal-Trabelsy M, Adir Y, Laor A, Vardi M, Bitterman H. Clinical characteristics and outcomes of patients with clinically unsuspected pulmonary embolism versus patients with clinically suspected pulmonary embolism. Respiration 2012; 84:492-500. [PMID: 22986339 DOI: 10.1159/000342324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 07/31/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The routine use of multidetector computed tomography has led to increased detection of unsuspected pulmonary embolism (UPE), with questionable benefit for diagnosis and treatment. OBJECTIVE The purpose of this work was to compare the clinical characteristics and prognosis of patients with UPE to patients with suspected PE (SPE). METHODS We retrospectively reviewed the charts of patients diagnosed with PE in a community-based university hospital between the years 2002 and 2007. UPE was defined as PE detected on CT scans performed for indications other than suspicion of PE. We compared patients with UPE to patients with SPE for differences in clinical features, electrocardiogram, imaging and echocardiographic findings. We also assessed the long-term outcomes using electronic patient records. RESULTS Of 500 patients with PE, 408 had SPE and 92 had UPE. Patients with UPE were similar to patients with SPE regarding age and sex distribution. Malignancy was more prevalent in UPE patients (39 vs. 23%, p < 0.0068). UPE patients had significantly less tachypnea (37 vs. 57%, p = 0.0005), dyspnea (47 vs. 87%, p < 0.0001), chest pain (19 vs. 42%, p < 0.0001) and hypoxemia (36 vs. 55%, p = 0.0011). Mortality was higher in UPE patients (70.3 vs. 53%, p = 0.0029). The hazard ratio after adjustment for confounders including age, sex and malignancy was 1.546 (95% CI: 1.139-2.099, p = 0.0052). CONCLUSIONS We suggest that UPE is more prevalent in patients with a malignancy and is associated with higher mortality despite a less severe clinical presentation. UPE may be a marker of poor prognosis.
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Freeman LM, Glaser JE, Haramati LB. Planar Ventilation-Perfusion Imaging for Pulmonary Embolism: The Case for “Outcomes” Medicine. Semin Nucl Med 2012; 42:3-10. [DOI: 10.1053/j.semnuclmed.2011.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abdel-Razeq HN, Mansour AH, Ismael YM. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome--a comprehensive cancer center experience. Vasc Health Risk Manag 2011; 7:153-8. [PMID: 21468175 PMCID: PMC3064456 DOI: 10.2147/vhrm.s17947] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE) in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described. METHODS Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness. RESULTS During the study period, 34 patients with incidental PE were identified. The mean age (±SD) was 57.7 (±12.4) years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77%) patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79%) patients had their PE while undergoing active treatment with chemotherapy (68%) or radiotherapy (12%); none, however, were on hormonal therapy. Most (74%) patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%), all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26%) died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated. CONCLUSION Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension, and sudden death.
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Shinagare AB, Guo M, Hatabu H, Krajewski KM, Andriole K, Van den Abbeele AD, DiPiro PJ, Nishino M. Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center. Cancer 2011; 117:3860-6. [PMID: 21319153 DOI: 10.1002/cncr.25941] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/08/2010] [Accepted: 12/16/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Incidence of pulmonary embolism (PE) for different cancer types in oncology outpatients is unknown. The purposes of the current study is to determine the incidence of PE in oncology outpatients and to investigate whether the incidence for PE is higher in certain cancers. METHODS A cohort of oncology outpatients who had imaging studies at Dana-Farber Cancer Institute, a tertiary outpatient cancer institute, from January 2004 through December 2009 was identified using research patient data registry. Radiology reports were reviewed to identify patients who developed PE. Incidences of PE in the total population and in each of 16 predefined cancer groups were calculated. Risk of PE for each cancer was compared using Fisher exact test. RESULTS A total of 13,783 patients was identified, of which 395 (2.87%; 95% confidence interval [CI], 2.59-3.16) developed PE. The incidence of PE was highest in the central nervous system ([CNS] 12.90%; 95% CI, 8.45-18.59), hepatobiliary (6.85%; 95% CI, 3.33-12.24), pancreatic (5.81%; 95% CI, 3.59-8.84), and upper gastrointestinal (5.81%; 95% CI, 3.96-8.20) malignancies. The risk of PE was significantly higher for CNS (P < .0001; odds ratio [OR], 5.28), pancreatic (P = .0027; OR, 2.15), upper gastrointestinal (P = .0002; OR, 2.18), and lung/pleural malignancies (P = .0028; OR, 1.45). There was significantly lower risk of PE for hematologic (incidence, 1.16%; 95% CI, 0.79-1.64; P < .0001; OR, 0.35) and breast malignancies (incidence, 1.50%; 95% CI, 1.02-2.11; P < .0001; OR, 0.47). CONCLUSIONS The incidence of PE in oncology outpatients in a tertiary cancer center during a 6-year period was 2.87%. CNS, pancreatic, upper gastrointestinal, and lung/pleural malignancies had a significantly higher risk for PE than other malignancies, whereas hematologic and breast malignancies had a significantly lower risk.
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Affiliation(s)
- Atul B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA
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Prevalence and Clinical History of Incidental, Asymptomatic Pulmonary Embolism: A Meta-Analysis. Thromb Res 2010; 125:518-22. [DOI: 10.1016/j.thromres.2010.03.016] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/25/2010] [Accepted: 03/28/2010] [Indexed: 11/22/2022]
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Abstract
Venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism, is a common disorder with at least 250 000 new events occurring each year in the United States alone. Treatment of venous thromboembolism includes anticoagulation, which is achieved initially with the use of a parenterally administered agent followed by a more prolonged course of treatment with an oral vitamin K antagonist. The duration of treatment depends on the clinical assessment of the benefit-to-risk ratio of prolonged anticoagulation versus the risk of recurrent events. In this review, we discuss some of the issues that we believe are among the most critical unanswered questions in the management of venous thromboembolism in the present era.
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Affiliation(s)
- Nigel S Key
- Harold R. Roberts Distinguished Professor, Division of Hematology/Oncology, Department of Medicine, 932 Mary Ellen Jones Bldg, CB #7035, Chapel Hill, NC 27599, USA.
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Langenberger H, Friedrich K, Plank C, Matzek W, Wolf F, Storto ML, Schaefer-Prokop C, Herold C. MDCT angiography for detection of pulmonary emboli: Comparison between equi-iodine doses of iomeprol 400mgI/mL and iodixanol 320mgI/mL. Eur J Radiol 2009; 70:579-88. [DOI: 10.1016/j.ejrad.2008.01.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 01/08/2008] [Accepted: 01/14/2008] [Indexed: 11/30/2022]
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Vascular Enhancement and Image Quality of MDCT Pulmonary Angiography in 400 Cases: Comparison of Standard and Low Kilovoltage Settings. AJR Am J Roentgenol 2009; 192:1651-6. [DOI: 10.2214/ajr.08.1730] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cancer patients and characteristics of pulmonary embolism. Eur J Radiol 2009; 69:478-82. [DOI: 10.1016/j.ejrad.2007.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 11/12/2007] [Accepted: 11/13/2007] [Indexed: 11/17/2022]
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Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 2, CT Angiography, Cardiac Function Assessment, and Noncoronary and Extracardiac Findings. AJR Am J Roentgenol 2009; 192:584-98. [DOI: 10.2214/ajr.08.1178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Is the lung scan alive and well? Facts and controversies in defining the role of lung scintigraphy for the diagnosis of pulmonary embolism in the era of MDCT. Eur J Nucl Med Mol Imaging 2009; 36:505-21. [DOI: 10.1007/s00259-008-1014-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 11/07/2008] [Indexed: 11/26/2022]
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22
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The prevalence of symptomatic and coincidental pulmonary embolism on computed tomography. J Comput Assist Tomogr 2008; 32:783-7. [PMID: 18830112 DOI: 10.1097/rct.0b013e31815a7aea] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the proportion of pulmonary embolism (PE) on computed tomographic pulmonary angiography (CTPA) and the proportion of coincidental PE on regular contrast-enhanced CT in oncological and nononcological patients. METHODS This study received internal review board approval and was Health Insurance Portability and Accountability Act compliant. All consecutive adult patients who had contrast-enhanced chest CT or dedicated CTPA during January 2005 were studied. Procedural codes were used to identify cases, and all CT images were reviewed. Clinical data collected included oncology status, chemotherapy regimen, site of tumor, and location of PE. chi2 Tests were used for statistical analysis. RESULTS Two hundred twenty-nine patients had CTPA, and 27 (11.8%) of them were positive for PE. Of 1168 patients who had contrast-enhanced CT for other indications, coincidental PE was found in 21 patients (1.8%). The proportions of coincidental PE were 3.3% of patients with progressive cancer, 2.5% of patients with stable cancer, 0.7% of patients with no evidence of cancer posttreatment, and 1.0% of nononcological patients. Coincidental PE was found more frequently in patients with progressive cancer compared with nononcological patients (P = 0.035). Patients who were on chemotherapy also had a higher risk of coincidental PE (P=0.019). CONCLUSIONS The prevalence of symptomatic PE on dedicated CTPA was 11.8%, and the rate of coincidental PE on contrast-enhanced CT was 1.8%. Coincidental PE was significantly higher inpatients with progressive cancer or those receiving chemotherapy.
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Tallón Guerola P, Arenas Jiménez J, de la Hoz Rosa J, Massutí Sureda B, García Marco JM. [The clinical and radiological characteristics and evolution of incidentally diagnosed pulmonary thromboembolism]. RADIOLOGIA 2008; 50:239-43. [PMID: 18471390 DOI: 10.1016/s0033-8338(08)71970-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the cases of pulmonary embolism (PE) detected incidentally in our hospital, the associated risk factors, clinical and radiological characteristics, and evolution. MATERIAL AND METHODS We retrospectively reviewed the reports of routine contrast-enhanced chest CT examinations performed during a 19-month period to detect cases in which PE was diagnosed incidentally. We found 18 cases of incidentally diagnosed PE and we reviewed the clinical histories and CT images of these patients to analyze the risk factors, clinical presentation, radiological characteristics, treatment, and evolution of PE in these cases. RESULTS We found 18 patients (9 men and 9 women; mean age: 61 years) with incidentally detected PE. The main risk factor for developing PE was the presence of a neoplasm (n = 16). No PE-related symptoms were present in 12 patients. A multidetector CT scanner was used for the examination in most cases (n = 16). PE was centrally located in 16 patients. Five patients were not treated with anticoagulation and no embolic events occurred in these patients. Two of the remaining patients died because of PE. CONCLUSIONS The incidental finding of PE can be common in oncological patients. Multidetector CT probably has a greater capacity for the incidental detection of PE in these patients. The outcome of incidentally detected PE can vary from death to remaining stable to spontaneous resolution.
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Affiliation(s)
- P Tallón Guerola
- Servicio de Radiodiagnóstico. Hospital General Universitario. Alicante. España
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Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V. Image Quality and Radiation Exposure at Pulmonary CT Angiography with 100- or 120-kVp Protocol: Prospective Randomized Study. Radiology 2007; 245:577-83. [PMID: 17940308 DOI: 10.1148/radiol.2452061919] [Citation(s) in RCA: 232] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph M Heyer
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG Clinics Bergmannsheil, Ruhr-University of Bochum, Buerkle-de-la-Camp Platz 1, D-44789, Bochum, Germany.
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