What do I do with this Pulmonary Embolism?

Today at Parkland Morning Report we had a great discussion about incidental pulmonary embolisms and how to manage them, especially when their clinical relevance to the patient is questionable. Below are two links to articles that address this issue as this remains a growing area of research.

Key Points:

– Meta-analysis performed and published in 2010 in Thrombosis Research which looked at 12 studies that included over ten thousand patients who received diagnosis of pulmonary embolism based on imaging that was ordered for another reason.

– Weighted mean prevalence of incidental pulmonary embolism was 2.6%. Inpatient status and malignancy were factors that were associated with a significant increased risk of pulmonary embolism.

– Incidental pulmonary embolisms may be associated with higher mortality rate, high recurrence rate if left untreated, and poorer prognosis in patients with cancer.

– The authors were unable to comment on the risk and benefit ratio of antithrombotic therapy due to lack of data.

– The other article is a survey of physicians and how they would manage incidental pulmonary embolisms in The Journal of Thrombosis and Haemostasis.

– Majority of physicians would treat incidental pulmonary embolism if it was centrally located compared to sub-segmental in the survey. However, if patient had malignancy then even more physicians would treat the pulmonary embolism (central and sub-segmental).