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.
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2021, Blood AdvancesCitation Excerpt :We did not identify any systematic reviews or RCTs that addressed this question. Our systematic search identified 9 observational studies that fulfilled, in part, the inclusion criteria.303,337-344 The certainty in the evidence from these observational studies of patients with single or multiple SSPEs was judged to be very low and was considered unreliable.
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2019, Thrombosis ResearchCitation Excerpt :It has also been hypothesized that the lung may act as a natural filter to protect systemic circulation and therefore, SSPE may represent a normal finding [10]. Moreover, direct and indirect evidence from retro- and prospective studies suggests that SSPE may have a less severe clinical presentation and a lower risk of venous thromboembolism (VTE) recurrence and PE-related death than more proximal PE [3,4,11], and that withholding anticoagulation in selected low-risk patients with SSPE (i.e., those without concomitant proximal deep vein thrombosis [DVT]) could be safe [4,12,13]. In contrast, another study found that patients with SSPE mimic those with more proximal PE in regard to their risk profile and clinical outcomes [5].
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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.