Subsegmental pulmonary embolism: is the emperor still naked?

RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates

“…[1–6] CTPA has become the dominant modality for diagnosing PE, with imaging rates for PE increasing well ahead of population growth, whilst the reported rate of positive scans (yield) has decreased. [2,3]ED CTPA usage has increased markedly, with EDs now often being the largest single initiator of CTPA within their hospitals. [7–10]…”

Wells Score and Poor Outcomes Among Adult Patients With Subsegmental Pulmonary Embolism

“…It has been recently proposed that, in addition to a currently ongoing trial on withholding anticoagulation in SSPE, a predictive score regarding SSPE risk profile could be useful in clinical decision making. 13 Other risk factors that might be associated with poor outcomes among this set of patients are the Charlson score, low albumin, and active cancer. Moreover, patients who present with SSPE after surgery (or other transient risk factor) might face lower incidence of complications during follow-up, likely due to the lower prevalence of a permanent thrombotic risk factor such as cancer.…”

“…Second, much SSPE may be incorrectly classified (ie, false positives) due to the limitations of the diagnostic procedure. 9,12,13 We are unaware of any previous studies that have attempted to stratify the risk of poor clinical outcomes in patients with SSPE. If such a risk stratification measure was available, it could have important clinical implications for treatment.…”

“…Second, much SSPE may be incorrectly classified (ie, false positives) due to the limitations of the diagnostic procedure. 9,12,13…”

Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

“…Although some studies have reported that in selected series of patients (without severe cardiovascular disease/with asymptomatic isolated sub-segmental PE), silent pulmonary embolism had a good prognosis and the anticoagulant treatment did not influence the resolution rate of PE, other authors have reported that most fatal PE are not suspected clinically and not treated, and most authors believe that occult pulmonary emboli may need to be treated even if treatment decisions are not clear [2,[19][20][21][22][23][24][25]. Malignancy and its treatment are known risk factors for pulmonary embolism, but clinical diagnosis of PE in these patients is often difficult due to comorbidities (diabetes, hypertension, cardiac failure, coronary artery disease).…”