Diagnosis and management of isolated subsegmental pulmonary embolism: Review and assessment of the options

Clinical and Applied Thrombosis/Hemostasis

Volumn 18, Issue 1, 2012, Pages 20-26

  Stein, Paul D ^a,b   Goodman, Lawrence R ^c   Hull, Russell D ^d   Dalen, James E ^e   Matta, Fadi ^a,b  

^a ST MARY MERCY HOSPITAL   (United States)

^b MICHIGAN STATE UNIVERSITY   (United States)

^c MEDICAL COLLEGE OF WISCONSIN   (United States)

^d UNIVERSITY OF CALGARY   (Canada)

^e UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE   (United States)

Author keywords

anticoagulant therapy; deep venous thrombosis; pulmonary embolism

Indexed keywords

ANTICOAGULANT AGENT; ANTIVITAMIN K; BARIUM SULFATE; CONTRAST MEDIUM;

ANTICOAGULANT THERAPY; AUTOPSY; BLEEDING; CARDIOPULMONARY FUNCTION; CENTRAL VENOUS CATHETERIZATION; CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION; CLINICAL ASSESSMENT; CLINICAL PROTOCOL; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; DEEP VEIN THROMBOSIS; DIAGNOSTIC ACCURACY; DIAGNOSTIC PROCEDURE; DIAGNOSTIC TEST ACCURACY STUDY; DISEASE DURATION; DRUG EFFICACY; DRUG FATALITY; DRUG SAFETY; ECHOGRAPHY; EVIDENCE BASED MEDICINE; HEART ATRIUM FIBRILLATION; HISTOPATHOLOGY; HUMAN; ISOLATED SUBSEGMENTAL PULMONARY EMBOLISM; LUNG ANGIOGRAPHY; LUNG EMBOLISM; LUNG SCINTISCANNING; LUNG VENTILATION PERFUSION RATIO; LUNG WEDGE PRESSURE; META ANALYSIS; MULTIDETECTOR COMPUTED TOMOGRAPHY; NON INVASIVE PROCEDURE; PATIENT SAFETY; PHLEBOGRAPHY; PRACTICE GUIDELINE; PREDICTIVE VALUE; PREVALENCE; PRIORITY JOURNAL; PROSPECTIVE STUDY; PULMONARY ARTERY; RECURRENT DISEASE; REVIEW; RISK BENEFIT ANALYSIS; RISK FACTOR; SENSITIVITY AND SPECIFICITY; SPIROMETRY; SURGICAL TECHNIQUE; VENOUS RETURN;

FEMALE; HUMANS; MALE; PULMONARY EMBOLISM; RECURRENCE; RISK FACTORS; TIME FACTORS;

EID: 84857526461     PISSN: 10760296     EISSN: 19382723     Source Type: Journal    
DOI: 10.1177/1076029611422363     Document Type: Review

References (63)

1. Goodman LR.. Small pulmonary emboli: what do we know?. Radiology. 2005 ; 234 (3). 654-658
2. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006 ; 354 (22). 2317-2327
3. Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F.. Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. Eur Radiol. 2005 ; 15 (10). 2057-2063
4. Patel S, Kazerooni EA, Cascade PN.. Pulmonary embolism: optimization of small pulmonary artery visualization at multi-detector row CT. Radiology. 2003 ; 227 (2). 455-460
5. Ghaye B.. Peripheral pulmonary embolism on multidetector CT pulmonary angiography. JBR-BTR. 2007 ; 90 (2). 100-108
6. Smith GT, Dammin GJ, Dexter L.. Postmortem arteriographic studies of the human lung in pulmonary embolization. JAMA. 1964 ; 188: 143-151
7. Galiè N, Kim NH.. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006 ; 3 (7). 571-576
8. Stein PD, Henry JW.. Prevalence of acute pulmonary embolism in central and subsegmental pulmonary arteries and relation to probability interpretation of ventilation/perfusion lung scans. Chest. 1997 ; 111 (5). 1246-1248
9. Goodman LR, Curtin JJ, Mewissen MW, et al. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography. AJR Am J Roentgenol. 1995 ; 164 (6). 1369-1374
10. Quinn MF, Lundell CJ, Klotz TA, et al. Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism. AJR Am J Roentgenol. 1987 ; 149 (3). 469-471
11. Oser RF, Zuckerman DA, Gutierrez FR, Brink JA.. Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging. Radiology. 1996 ; 199 (1). 31-35
12. Lette J, Cerino M, Eybalin MC, Levasseur A.. Prevalence and clinical significance of solitary pulmonary sub-segmental microembolism. Nucl Med Rev Cent East Eur. 2004 ; 7 (1). 39-42
13. Diffin DC, Leyendecker JR, Johnson SP, Zucker RJ, Grebe PJ.. Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography. AJR Am J Roentgenol. 1998 ; 171: 1085-1089
14. Cha SI, Shin KM, Lee JW, et al. Clinical characteristics of patients with peripheral pulmonary embolism. Respiration. 2010 ; 80 (6). 500-508
15. de Monyé W, van Strijen MJ, Huisman MV, Kieft GJ, Pattynama PM.. Suspected pulmonary embolism: prevalence and anatomic distribution in 487 consecutive patients. Advances in new technologies evaluating the localisation of pulmonary embolism (ANTELOPE) group. Radiology. 2000 ; 215 (1). 184-188
16. Van Strijen MJ, De Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MV.. Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy. J Thromb Haemost. 2005 ; 3 (1). 17-25
17. Thomeer MG, Pattynama PM, Hartmann IJ, Kieft GJ, Van Strijen MJ.. High incidence of isolated subsegmental pulmonary emboli on multi-slice spiral CT: a comparative clinical study. Thromb Haemost. 2006 ; 95 (5). 914-915
18. Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007 ; 298 (23). 2743-2753
19. Perrier A, Roy PM, Sanchez O, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005 ; 352 (17). 1760-1768
20. Nijkeuter M, Kwakkel-van Erp JM, Kruip MJ, et al. Christopher study investigators. Incidence of diagnosis of subsegmental pulmonary emboli using multidetector row and single-detector row computed tomography. J Thromb Haemost. 2008 ; 6 (2). 384-386
21. Douma RA, Hofstee HM, Schaefer-Prokop C, et al. Comparison of 4- and 64-slice CT scanning in the diagnosis of pulmonary embolism. Thromb Haemost. 2010 ; 103 (1). 242-246
22. Ghanima W, Abdelnoor M, Holmen LO, Nielssen BE, Sandset PM.. The association between the proximal extension of the clot and the severity of pulmonary embolism (PE): a proposal for a new radiological score for PE. J Intern Med. 2007 ; 261 (1). 74-81
23. Eyer BA, Goodman LR, Washington L.. Clinicians' response to radiologists' reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT. AJR Am J Roentgenol. 2005 ; 184 (2). 623-628
24. Donato AA, Khoche S, Santora J, Wagner B.. Clinical outcomes in patients with isolated subsegmental pulmonary emboli diagnosed by multidetector CT pulmonary angiography. Thromb Res. 2010 ; 126 (4). e266 - e270
25. Kluge A, Luboldt W, Bachmann G.. Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol. 2006 ; 187 (1). W7 - W14
26. Suh JM, Cronan JJ, Healey TT.. Dots are not clots: the over-diagnosis and over-treatment of PE. Emerg Radiol. 2010 ; 17 (5). 347-352
27. NazaroÄŸlu H, Ozmen CA, Akay HO, Kilinç I, Bilici A.. 64-MDCT pulmonary angiography and CT venography in the diagnosis of thromboembolic disease. AJR Am J Roentgenol. 2009 ; 192 (3). 654-661
28. Winston CB, Wechsler RJ, Salazar AM, Kurtz AB, Spirn PW.. Incidental pulmonary emboli detected at helical CT: effect on patient care. Radiology. 1996 ; 201 (1). 23-27
29. Gosselin MV, Rubin GD, Leung AN, Huang J, Rizk NW.. Unsuspected pulmonary embolism: prospective detection on routine helical CT scans. Radiology. 1998 ; 208 (1). 209-215
30. Storto ML, Di Credico A, Guido F, Larici AR, Bonomo L.. Incidental detection of pulmonary emboli on routine MDCT of the chest. AJR Am J Roentgenol. 2005 ; 184 (1). 264-267
31. Ritchie G, McGurk S, McCreath C, Graham C, Murchison JT.. Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning. Thorax. 2007 ; 62 (6). 536-540
32. Carrier M, Righini M, Wells PS, et al. Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemost. 2010 ; 8 (8). 1716-1722
33. Gurney JW.. No fooling around: direct visualization of pulmonary embolism. Radiology. 1993 ; 188 (3). 618-619
34. Stein PD.. Wedge arteriography for the identification of pulmonary emboli in small vessels. Am Heart J. 1971 ; 82 (5). 618-623
35. Stein PD, Leu JD, Welch MH, Guenter CA.. Patho physiology of the pulmonary circulation in emphysema associated with alpha1 antitrypsin deficiency. Circulation. 1971 ; 43 (2). 227-239
36. Goodman LR, Stein PD, Matta F, et al. CT venography and compression ultrasound are diagnostically equivalent: Data from PIOPED II. Am J Roentgen. 2007 ; 189 (5). 1071-1076
37. Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F.. Diagnosis and management of subsegmental pulmonary embolism. J Thromb Haemost. 2006 ; 4 (4). 724-731
38. Schultz DJ, Brasel KJ, Washington L, et al. Incidence of asymptomatic pulmonary embolism in moderately to severely injured trauma patients. J Trauma. 2004 ; 56 (4). 727-731
39. Engelke C, Rummeny EJ, Marten K.. Pulmonary embolism at multi-detector row CT of chest: One-year survival of treated and untreated patients. Radiology. 2006 ; 239 (2). 563-575
40. Linkins LA, Choi PT, Douketis JD.. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann Intern Med. 2003 ; 139 (11). 893-900
41. Pollack CV, Schreiber D, Goldhaber SZ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011 ; 57 (6). 700-706
42. Hull RD, Raskob GE, Ginsberg JS, et al. Noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch Intern Med. 1994 ; 154 (3). 289-297
43. Hull RD, Raskob GE, Coates G, Panju AA, Gill GJ.. A new noninvasive management strategy for patients with suspected pulmonary embolism. Arch Intern Med. 1989 ; 149 (11). 2549-2555
44. Wells PS, Ginsberg JS, Anderson DR, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998 ; 129 (12). 997-1005
45. Sevitt S, Gallagher N.. Venous thrombosis and pulmonary embolism: a clinico-pathological study in injured and burned patients. Br J Surg. 1961 ; 48: 475-489
46. Short DS.. A survey of pulmonary embolism in a general hospital. Brit Med J. 1952 ; 1 (4762). 790-796
47. Byrne JJ, O'Neil EE.. Fatal pulmonary emboli. A study of 130 autopsy-proven fatal emboli. Am J Surg. 1952 ; 83 (1). 47-54
48. Cohn R, Walsh J.. The incidence and anatomical site of origin of pulmonary emboli. Stanford Med Bull. 1946 ; 4 (3-4). 97-99
49. Stein PD, Hull RD, Raskob GE.. Withholding treatment in patients with acute pulmonary embolism who have a high risk of bleeding and negative serial noninvasive leg tests. Am J Med. 2000 ; 109 (4). 301-306
50. Stein PD, Henry JW, Relyea B.. Untreated patients with pulmonary embolism: outcome, clinical and laboratory assessment. Chest. 1995 ; 107 (4). 931-935
51. Turkstra F, Kuijer PM, van Beek EJ, Brandjes DP, ten Cate JW, Buller HR.. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med. 1997 ; 126 (10). 775-781
52. Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J.. Deep venous thrombosis: US assessment using vein compression. Radiology. 1987 ; 162 (1 pt 1). 191-194
53. Pedersen OM, Aslaksen A, Vik-Mo H, Bassoe AM.. Compression ultrasonography in hospitalized patients with suspected deep venous thrombosis. Arch Intern Med. 1991 ; 151 (11). 2217-2220
54. Lensing AW, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989 ; 320 (6). 342-345
55. O'Leary DH, Kane RA, Chase BM.. A prospective study of the efficacy of B-scan sonography in the detection of deep venous thrombosis in the lower extremities. J Clin Ultrasound. 1988 ; 16 (1). 1-8
56. Lewis BD, James EM, Welch TJ, Joyce JW, Hallett JW, Weaver AL.. Diagnosis of acute deep venous thrombosis of the lower extremities: prospective evaluation of color doppler flow imaging versus venography. Radiology. 1994 ; 192 (3). 651-655
57. Froehlich JA, Dorfman GS, Cronan JJ, Urbanek PJ, Herndon JH, Aaron RK.. Compression ultrasonography for the detection of deep venous thrombosis in patients who have a fracture of the hip. A prospective study. J Bone Joint Surg Am. 1989 ; 71 (2). 249-256
58. Davidson BL, Elliott CG, Lensing AW.. Low accuracy of color doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. The RD Heparin Arthroplasty Group. Ann Intern Med. 1992 ; 117: 735-738
59. Lensing AW, Doris CI, McGrath FP, et al. A comparison of compression ultrasound with color doppler ultrasound for the diagnosis of symptomless postoperative deep vein thrombosis. Arch Intern Med. 1997 ; 157 (7). 765-768
60. Schellong SM, Beyer J, Kakkar AK, et al. Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study. J Thromb Haemost. 2007 ; 5 (7). 1431-1437
61. Beyer-Westendorf J, Halbritter K, Platzbecker E, et al. Central adjudication of venous ultrasound in VTE screening trials-reasons for failure. J Thromb Haemost. 2010 ; 9 (3). 457-463
62. Kearon C, Kahn SR, Agnelli G, et al. American College of Chest Physicians. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 ; 133 (6 suppl). 454S - 545S
63. Remy-Jardin M, Pistolesi M, Goodman LR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner society. Radiology. 2007 ; 245 (2). 315-329