Clinically unsuspected pulmonary embolism—an important secondary finding in oncology CT
Introduction
There is an increased risk of pulmonary embolism (PE) in patients with malignancy. This increased risk is four-fold above the general population and increases to six-fold if the patient is receiving chemotherapy.1 PE rates of between 1 and 43% have been reported depending on the tumour type, stage and chemotherapeutic regimen.2 A significant proportion of patients with PE will have a non-specific presentation3 or will be asymptomatic.4 Incidental PE is occasionally detected in our centre during staging or follow-up computed tomography (CT) examinations of oncology patients. A prospective study was undertaken to determine the rate of this finding in our institution and compare this with rates described in the literature.
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Materials and methods
Three hundred and eighty-five consecutive chest CT examinations in patients with malignancy were prospectively evaluated by a single consultant radiologist as part of the standard reporting of these CT images. This radiologist had 2 years experience as a consultant reporting mainly oncology CT. The cases occurred over a 9-month period from October 2003 to June 2004. Review of the pulmonary arteries is standard practice for evaluation of these images,5, 6 and the reporting process was not
Results
Of the 385 patients studied, 51% (196/385) were males and 49% (189/385) were females. The average patient age was 61 years (range 22–94 years). Ten patients had visible PE on their CT images. In nine of these PE had not been observed before, this being the first time PE had been diagnosed for the patient. In one (patient 2) PE had been incidentally noted on a staging CT examination 8 weeks earlier, but as the observation at that time was also entirely incidental, it was felt valid to include
Discussion
Cancer patients often undergo multiple CT investigations as part of their cancer staging and treatment monitoring. Review of the pulmonary arterial tree on these examinations will reveal PE in a small, but potentially clinically significant, percentage of cases. The best method of visualization is clearly at the work station using windowing specifically tailored to the pulmonary vascular tree in question. Conventional soft-tissue windows often do not show the pulmonary arteries well as the
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