Christoph Engelke MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: To retrospectively assess the frequency, severity and outcome of clinically unsuspected pulmonary embolism (PE) on routine multislice CT (MCT) of the chest. Methods and Materials: This was a retrospective quasi-experimental intervention study. 2300 consecutive chest MCT scans of 1783 patients were reviewed over a one-year retrospective study period. A consensus-based CT review of all preselected positive patients was performed by two experienced chest radiologists and included severity assessment on basis of the modified Miller score. The incidences and PE severities of suspected and unsuspected, true positive and false negative studies were determined in comparison with radiology reports. From the review of the in-patient notes the 30-day patient outcomes of treated and untreated patients including complications of therapy, PE, PE-recurrence and death were obtained. Statistical analysis of PE severity and mortality was performed using Mann-Whitney U test. Results: A total of 117 patients were identified as PE positive (incidence of PE of 6.6%). Patient file review was complete in 94 patients. There were 30 true positive scans in patients clinically suspected of having PE (group A). 18 MCT scans of patients not clinically suspected of having PE were confirmed as true positive for incidental PE (group B) and 46 as false negative for incidental PE (group C). The mean PE severities were 6.5, 3,1 and 2.9 (modified Miller score) in groups A, B and C, respectively (p<0.05 for comparison group A vs. B, C). Of these 94 patients 44, 26 and 25 patients received therapeutic anticoagulation/thrombolysis, prophylactic anticoagulation and no therapy, respectively. The bleeding complication rates in patients with therapeutic, prophylactic anticoagulation and no treatment were 6/44 (4 major bleeds), 0/26 and 0/25, respectively. Other complications in these groups occurred in 12/44, 5/26 and 3/25 patients, respectively. Recurrent PE (2 patients) was only observed in the treated patients. Three patients (7%) of those receiving therapeutic anticoagulation but no other patient died (total 30-day mortality of 3%, p<0.0001), two attributable to PE, and one due to intracranial hemorrhage. Conclusion: The initial short-term outcome data do not indicate a worse fate of untreated patients with minor PE, but a significantly worse outcome of patients treated for PE with two deaths attributable to PE and one to hemorrhage. A longer follow-up is required to establish, if patients with incidental PE do not require treatment.       Questions about this event email: cengelke@roe.med.tu-muenchen.de

Engelke MD, C, Diagnosis and Outcome of Incidental Undiagnosed Pulmonary Embolism at Multislice CT of the Chest.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3107418.html