Regular ArticleClinical outcomes in patients with isolated subsegmental pulmonary emboli diagnosed by multidetector CT pulmonary angiography☆
Section snippets
Patient selection
This study was performed in a 754-bed community hospital with a Level 2 Trauma Center and 110,000 emergency department visits per year. A retrospective analysis of the dictated reports of 10,453 CT Chest studies performed with contrast from the start of use of multidetector CT scanning (October 19, 2001) until December 31, 2007 was undertaken. Records were identified by computerized identification of all Current Procedural Terminology (CPT) codes for CT chest with contrast (CPT codes 71260 and
Results
During the 74-month review period, 10,453 patients underwent CT chest scanning with contrast, of which pulmonary emboli were diagnosed in 1,463 (14%) (Fig. 1). One hundred fifteen of those (7.9% of total) were isolated to one or more subsegmental branches without more proximal thrombus and were considered for further study. One hundred and seven patients had images and reports externally re-reviewed to confirm diagnosis and absence of other emboli, while eight had dictated reports re-reviewed
Discussion
This study found that three-month outcomes in patients diagnosed with ISSPE (1.05% recurrence, 0% VTE-related mortality) were significantly more favorable than the outcomes in the literature of anticoagulated patients with typical pulmonary emboli (8% recurrence, 1.7% mortality) [12]. Our results are similar to other authors’ findings who followed 3-month outcomes of patients with ISSPE (Table 1), which suggest, in aggregate, a recurrence rate of 1/192 (0.5%; 95% CI: 0-2.9%) with no PE-
Conflict of interest statement
Drs. Donato, Khoche, Wagner and Mr. Santora have no financial interests or personal relationships with people or organizations to disclose that pertain to this manuscript. The authors have no funding sources or sponsors to disclose.
References (28)
- et al.
Natural history of pulmonary embolism
Prog Cardiovasc Dis
(Feb 1975) - et al.
Diagnosis and management of subsegmental pulmonary embolism
J Thromb Haemost
(Apr 2006) - et al.
Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism
J Vasc Interv Radiol
(Jun 1999) - et al.
Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings: a cohort study
Mayo Clin Proc
(Feb 2002) - et al.
Do anticoagulants improve survival in patients presenting with venous thromboembolism?
J Intern Med
(Dec 2003) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators
JAMA
(May 23 1990)- et al.
Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT
Radiology
(Feb 2002) - et al.
Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography
Ann Intern Med
(Dec 7 2004) - et al.
Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial
JAMA
(Dec 19 2007) - et al.
Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis
Eur Radiol
(Aug 2002)
Clinicians' response to radiologists' reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT
AJR Am J Roentgenol
Imaging of pulmonary embolism: too much of a good thing?
JAMA
Death due to recurrent thromboembolism among younger healthier individuals hospitalized for idiopathic pulmonary embolism
Thromb Haemost
Two-sided confidence intervals for the single proportion: comparison of seven methods
Stat Med
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2019, Thrombosis ResearchCitation Excerpt :Acute isolated subsegmental pulmonary embolism (SSPE), defined as pulmonary embolism (PE) that occurs in one or more subsegmental pulmonary artery branches but no larger order of vessels [1], is increasingly detected with the technological advance in computed tomography pulmonary angiography (CTPA) [2]. SSPE represents 7–36% of cases of PE [3–6], and the vast majority of patients with SSPE receive anticoagulant treatment [6]. However, the diagnosis and treatment of SSPE pose several challenges.
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Research carried out at The Reading Hospital and Medical Center, West Reading, PA, 19612.
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Dr. Anthony Donato had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis. He and his co-authors have no conflicts of interest with regards to this manuscript.