Anna Rita Larici MD, Presenter: Nothing to Disclose

Annemilia Del Ciello, Abstract Co-Author: Nothing to Disclose

Fabio Maggi MD, Abstract Co-Author: Nothing to Disclose

Alessandra Farchione, Abstract Co-Author: Nothing to Disclose

Antonio Cipriani, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

To assess the prevalence of Pulmonary Embolism (PE) incidentally detected on routine MDCT exams of the chest in oncology inpatients without any evidence of suggestive symptoms (asymptomatic PE) and the PE prevalence in symptomatic patients in the same time period.

A prospective review of routine contrast-enhanced 16- and 64-rows CT scans of the chest in 551 consecutive neoplastic inpatients (mean age: 59 yrs) was undertaken. CT angiograms performed for suspected pulmonary embolism or aortic disease as well as exams of poor quality were excluded. CT scans (collimation: 2.5 mm/1.25 mm) were evaluated by two chest radiologists in consensus to look for presence and proximal distribution of PE. Demographics (age, sex), clinical information (tumor type, presence or absence of symptoms suggestive of PE) and risk factors for thromboembolism other than neoplasm (metastases, ongoing chemotherapy, central venous catheter, immobilization, recent surgery) were prospectively obtained from charts. Alternative CT findings that could justify symptoms in patients with PE were searched. Prevalence of PE in asymptomatic and symptomatic patients was calculated.

Incidentally PE was present in 21 of 551 neoplastic inpatients (mean age: 70 yrs) with an overall prevalence of 3.8%. 11/21 (52%) patients were asymptomatic with a PE prevalence of 2%. 10/21 (48%) patients had symptoms suggestive of PE (dyspnea: 7 patients; dyspnea and fatigue: 3 patients) at the time of CT exam, with a PE prevalence of 1.8%. None of symptomatic patients had alternative CT findings than PE that could explain dyspnea. Most of PE patients (18/21, 95%) had multiple coexisting risk factors for thromboembolism. Metastases, chemotherapy and central venous catheter were the most frequent, with a respective prevalence of 62% (13/21), 47% (10/21) and 43% (9/21).

Prevalence of incidental asymptomatic PE in oncology inpatients is low. A considerable number of patients with PE may have dyspnea which can be overlooked by referring clinicians. The majority of patients with PE had multiple risk factors as metastatic disease and ongoing chemotherapy.

Radiologists should carefully analyze pulmonary arteries on routine chest MDCT in patients with advanced neoplasm. Clinicians should be aware that dyspnea may also be due to PE in oncology patients.

Larici, A, Del Ciello, A, Maggi, F, Farchione, A, Cipriani, A, Bonomo, L, Incidental Asymptomatic vs Symptomatic Pulmonary Embolism on MDCT: A Prospective Study of Prevalence in Oncology Inpatients.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014706.html