INCIDENTAL PULMONARY EMBOLI DETECTED AT HELICAL CT - EFFECT ON PATIENT-CARE

PURPOSE: To evaluate incidental pulmonary emboli detected at helical c omputed tomography (CT) and the effect on patient care. MATERIALS AND METHODS: A computer search of reports from 1,879 consecutive contrast material-enhanced helical CT scans identified 28 cases in which pulmon ary emboli were suggested. These 28 scans were rereviewed by three rad iologists to confirm intraluminal defects. Six cases were excluded (th ree because of tumor invasion, two arterial stump thrombi after pneumo nectomy, one artifact). In four cases, pulmonary emboli were clinicall y suspected or diagnosed prior to CT. Pulmonary embolus was not suspec ted at CT in the remaining 18 patients who constituted the study group . The medical records were reviewed for predisposing factors, suspicio n of pulmonary embolism, adjuvant studies, and resultant therapy. RESU LTS: All 18 patients in the study group had predisposition for thrombo embolic disease. Seven of these patients underwent confirmatory or cor relative studies (angiography, radionuclide studies, or autopsy), and four patients had supportive studies documenting deep venous thrombosi s. Eleven patients received anticoagulants or caval filter placement a s a result of CT findings. CONCLUSION: Incidental pulmonary emboli wer e detected in approximately 1% of patients who underwent contrast-enha nced CT of the chest. All of these patients were at high risk for embo li. Therapeutic intervention was undertaken in 61% of these patients. While ultimate patient outcome is uncertain, the incidental CT diagnos is of pulmonary emboli appears accurate and affects patient care.