Malignancy and Pulmonary Thromboembolism: Comparison of Symptomatic Cases with the Incidental Ones

Abstract

Objectives: The use of advanced techniques of computed tomography (CT) was resulted in increased incidentally detected pulmonary embolism in oncology patients undergoing routine cancer staging CT scans. The aim of this study was to compare the symptomatic and incidental pulmonary emboli cases in oncologic patients. Methods: The medical data of the patients diagnosed with pulmonary embolism (ICD: I.26) and had an underlying malignancy were evaluated retrospectively from the hospital records between the years of 2009 and 2013. Right ventricle dilatation findings were evaluated from the thorax CT. Results: There were 38 women (44.2%), 48 men (55.8%), totally 86 patients. The mean age was 61.7 ± 11.9 years and the median duration of follow-up was six months. The most common underlying malignancies were gastrointestinal (29.4%), lung (22.4%), genitourinary (21.2%) and breast cancers (10.6%). Pulmonary thromboembolism was diagnosed incidentally on routine control thorax CT in thirty-nine of the cases (45.3%). When the incidental cases compared to symptomatic ones; no statistically significant difference was found with respect to the type of malignancy, chemotherapy history, presence of metastasis and evidence of septum flattening on thorax CT. The presence of bilaterally thrombus was found as increased in symptomatic cases compared to incidental ones and the difference was statistically significant (p = 0.026). It was found that the RV/LV ratio was significantly higher in symptomatic cases (p = 0.03). Conclusion: A considerable number of pulmonary thromboemboli episodes could be asymptomatic in malignant patients. It is suggested that the sub-massive clinical course and preserved right ventricle functions could be the reason of asymptomatic events.