Elsevier

Thrombosis Research

Volume 126, Issue 4, October 2010, Pages e266-e270
Thrombosis Research

Regular Article
Clinical outcomes in patients with isolated subsegmental pulmonary emboli diagnosed by multidetector CT pulmonary angiography

https://doi.org/10.1016/j.thromres.2010.07.001Get rights and content

Abstract

Introduction

CT Pulmonary Angiography has been shown to be equivalent to Ventilation/ Perfusion scanning in 3-month outcome studies, but it detects more pulmonary emboli. Isolated subsegmental pulmonary emboli are thought to account for some of the increase in diagnosis, but it is not known whether these emboli represent a harbinger for future thromboembolic events. The objective of this study was to determine the 3-month clinical outcomes of a cohort of patients diagnosed with isolated subsegmental pulmonary emboli.

Materials and Methods

Review of 10,453 consecutive CTPA radiology reports over 74-month period since the implementation of Multidetector CT Pulmonary Angiography identified a cohort of 93 patients found to have acute pulmonary embolism isolated to subsegmental pulmonary arteries without other evidence of deep venous thrombosis at one institution. The study measured 3-month clinical outcomes (anticoagulation use, recurrence, death, hemorrhage) determined by review of records and telephone interviews with physicians.

Results

Seventy-one patients (76%) were treated with anticoagulation and/or IVC filter, while 22 (24%) were observed without therapy. One patient (1/93, 1.05%; 95% CI: 0-6.6%) who was treated with anticoagulants and a vena caval filter had a recurrent subsegmental pulmonary embolus. No patients died of pulmonary embolism. There were 8 hemorrhages, including 5 (5.3%) major hemorrhages without any hemorrhage-related mortality.

Conclusions

Patients diagnosed with isolated subsegmental pulmonary emboli have favorable 3-month outcomes. Short-term prognosis for recurrent thromboembolism may be lower than the risk of adverse events with anticoagulation in patients at high risk of hemorrhage.

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.

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    Research carried out at The Reading Hospital and Medical Center, West Reading, PA, 19612.

    1

    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.

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