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The clinician's response to a report of an incidental pulmonary embolism detected on multidetector CT
  1. James M Franklin,
  2. Najib Rahman,
  3. Fergus V Gleeson
  1. Oxford Radcliffe Hospitals, UK
  1. Correspondence to Dr James Franklin, Department of Radiology, Churchill Hospital, Oxford OX3 7LJ; james.franklin{at}nds.ox.ac.uk

Abstract

Background The prevalence of incidental pulmonary emboli (PE) detected on contrast enhanced CT performed for other reasons is approximately 2.5%. The treatment decisions based upon the discovery of incidental PE have been less well reported. The purpose of this study was to report the clinician's response to, and consequences of, the finding of incidental PE on contrast enhanced CT.

Methods Retrospective cohort study. Patients with incidental PE detected on a contrast enhanced CT were retrospectively identified at a single institution between 1 January 2009 and 31 December 2009. Case note review was performed to assess clinicians' responses to this finding. Patients with synchronous venous thromboembolism, unrecognised symptoms or factors preventing response assessment were excluded from this analysis. Patient and PE characteristics, treatment, and outcomes related to treatment and non-treatment were recorded.

Results There were 73 patients with incidental PE: 52 were in the proximal pulmonary arteries and 21 were distal. 16 patients were excluded from the treatment analysis. 52 of 57 (91.2%) patients were treated with therapeutic anticoagulation. There were 2 (3.8%) serious adverse events related to treatment. 5 (8.8%) patients were not treated; 2 (40%) developed recurrent venous thromboembolism. Treatment of incidental PE was not significantly associated with patient age, PE risk factors or PE location. A smaller proportion of single incidental PE were treated than multiple incidental PE (p=0.047).

Conclusion There is morbidity associated with both treatment and non-treatment of incidental PE. However, despite the uncertainty about the natural history and clinical significance of incidental PE, the majority of patients at the authors' institution received prompt anticoagulation.

  • Pulmonary embolism
  • incidental findings
  • tomography
  • x-ray computed
  • radiology & imaging
  • chest imaging

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Footnotes

  • Competing interests None declared.

  • Ethics approval Ethical review was performed and approval was given for this study to be performed as an audit, without specific consent. This was registered as an audit with the Audit Office at our institution.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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