This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O'Connell, C. L. Articles by Liebman, H. A. Search for Related Content PubMed PubMed Citation Articles by O'Connell, C. L. Articles by Liebman, H. A. Social Bookmarking                            What's this?

Unsuspected Pulmonary Emboli in Cancer Patients: Clinical Correlates and Relevance

Casey L. O'Connell, William D. Boswell, Vinay Duddalwar, Amy Caton, Lisa S. Mark, Cheryl Vigen, Howard A. Liebman

From the Division of Hematology, Department of Medicine; Department of Radiology; and the Department of Preventive Medicine, University of Southern California-Keck School of Medicine, Los Angeles, CA

Address reprint requests to Howard A. Liebman, MD, Division of Hematology, Kenneth Norris Jr Cancer Center, Rm 3466, 1441 Eastlake Ave, Los Angeles, CA 90033; e-mail: liebman{at}hsc.usc.edu

PURPOSE: Advances in computed tomography (CT) scanning have led to the detection of unsuspected pulmonary emboli (PE) on routine cancer staging scans. We hypothesized that these patients had signs or symptoms suggestive of PE that may have been overlooked by their health care providers.

PATIENTS AND METHODS: A retrospective chart review was performed on 59 patients found on routine cancer staging CT scans to have unsuspected PE. Information on patient demographics, malignancy characteristics, risk factors for venous thromboembolism (VTE), and symptoms was recorded. A retrospective case-control analysis was then performed using two age- and stage-matched control patients for each patient who had similar staging CT scans performed during the same period.

RESULTS: Fifty-two patients with unsuspected PE were identified. Forty-four percent had signs or symptoms commonly associated with PE; when fatigue was included, 75% were symptomatic. Ninety-two control patients were identified for 46 of the case patients. Patients with unsuspected PE were significantly more likely to have had a prior history of VTE (20% v 3%; P = .007). The patients with PE were significantly more likely than control patients to complain of fatigue (54% v 20%; P = .0002) and shortness of breath (22% v 8%; P = .02). There was no difference between the groups in administration of chemotherapy within 30 days, central venous catheter use, or erythropoietin therapy.

CONCLUSION: Seventy-five percent of patients found to have unsuspected PE on cancer staging CT scans were symptomatic. Fatigue and shortness of breath were significantly more common in patients with unsuspected PE than in control patients.

Supported by a grant from the Vanoff Family Foundation and Max Gondon.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. A. Khorana, M. B. Streiff, D. Farge, M. Mandala, P. Debourdeau, F. Cajfinger, M. Marty, A. Falanga, and G. H. Lyman Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action J. Clin. Oncol., October 10, 2009; 27(29): 4919 - 4926. [Abstract] [Full Text] [PDF]

				M. B. Streiff Diagnosis and Initial Treatment of Venous Thromboembolism in Patients With Cancer J. Clin. Oncol., October 10, 2009; 27(29): 4889 - 4894. [Abstract] [Full Text] [PDF]

				G. H. Lyman and A. A. Khorana Cancer, Clots and Consensus: New Understanding of an Old Problem J. Clin. Oncol., October 10, 2009; 27(29): 4821 - 4826. [Full Text] [PDF]

				C. L O'Connell, M. Ghalichi, S. Boyle, S. Vasan, W. Boswell, P. Razavi, K. Grabow, L. Mark, A. Caton, and H. Liebman Unsuspected Pulmonary Emboli Identified on Routine Cancer Staging MDCT Scans: Impact on Cancer Survival Blood (ASH Annual Meeting Abstracts), November 16, 2008; 112(11): 3818 - 3818. [Abstract] [Full Text]

				P U Dalal Non-metastatic manifestations of cancer in the chest Imaging, September 1, 2008; 20(3): 194 - 204. [Abstract] [Full Text] [PDF]

				C. Kearon, S. R. Kahn, G. Agnelli, S. Goldhaber, G. E. Raskob, and A. J. Comerota Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 454S - 545S. [Abstract] [Full Text] [PDF]

				A. Falanga, A. Y. Y. Lee, M. B. Streiff, and G. H. Lyman Anticoagulation in the Treatment of Venous Thromboembolism in Patients with Cancer ASCO Educational Book, January 1, 2008; 2008(1): 258 - 268. [Abstract] [Full Text] [PDF]

				A. R. Larici, L. Calandriello, F. Maggi, M. Torge, L. Bonomo, G. W. Gladish, D. H. Choe, E. M. Marom, B. S. Sabloff, and R. F. Munden Prevalence of Incidental Pulmonary Emboli in Oncology Patients Radiology, December 1, 2007; 245(3): 921 - 922. [Full Text] [PDF]