A case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imaging
<strong> OBJECTIVES:</strong> The risk of recurrent venous thromboembolic disease and the management of patients with isolated subsegmental pulmonary embolism (SSPE) remain unclear. We sought to assess the long-term clinical outcome of patients with isolated SSPE demonstrated by isolate...
| Main Authors: | , , , , , |
|---|---|
| 格式: | Journal article |
| 出版: |
Lippincott, Williams and Wilkins
2018
|
| _version_ | 1826288490974806016 |
|---|---|
| author | Mallorie, A Chan, K Ioannidis, S Stubbs, M Navalkissoor, S Wagner, T |
| author_facet | Mallorie, A Chan, K Ioannidis, S Stubbs, M Navalkissoor, S Wagner, T |
| author_sort | Mallorie, A |
| collection | OXFORD |
| description | <strong> OBJECTIVES:</strong> The risk of recurrent venous thromboembolic disease and the management of patients with isolated subsegmental pulmonary embolism (SSPE) remain unclear. We sought to assess the long-term clinical outcome of patients with isolated SSPE demonstrated by isolated subsegmental mismatch found on ventilation/perfusion (V/Q) scans. <strong>PATIENTS AND METHODS:</strong> We performed a retrospective observational study of 1300 consecutive patients with suspected pulmonary embolism who underwent index V/Q single-photon emission computed tomography between 2012 and 2013. Forty (3%) patients were found to have isolated SSPE identified on V/Q scan. Of the 40 patients with isolated SSPE on V/Q scan, 19 underwent further investigation with computed tomography pulmonary angiogram (CTPA) within 48 h. <strong>RESULTS:</strong> Among 19 patients who had corroborating CTPA performed concurrently, 94.7% of the SSPEs identified on V/Q were not detectable on CTPA. Of the 40 patients, 10 (25%) were anticoagulated. In a median follow-up of 3.28±0.55 years, all-cause mortality occurred in two patients, recurrence of suspected venous thromboembolism (VTE) occurred in 12 (30%) of 40 patients, but none had confirmed recurrent thromboembolism on further imaging. In the 40 patients with SSPE on V/Q, there was no difference in the risk of recurrence of suspected VTE or mortality between patients treated with anticoagulation and not treated (hazard ratio: 2.04, 95% confidence interval: 0.75-7.28). <strong>CONCLUSION: </strong> In this case series, a large proportion of patients with isolated SSPE on V/Q imaging were not identified on corroborating CTPA performed within 48 h. In patients with isolated SSPE (identified by isolated subsegmental mismatch on V/Q single-photon emission computed tomography), we found no difference in risk of recurrent suspected VTE or all-cause mortality in those treated with anticoagulation and those not treated. |
| first_indexed | 2024-03-07T02:14:30Z |
| format | Journal article |
| id | oxford-uuid:a1c44824-e6c3-49cf-bd7b-5e16c048d93f |
| institution | University of Oxford |
| last_indexed | 2024-03-07T02:14:30Z |
| publishDate | 2018 |
| publisher | Lippincott, Williams and Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:a1c44824-e6c3-49cf-bd7b-5e16c048d93f2022-03-27T02:15:27ZA case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imagingJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a1c44824-e6c3-49cf-bd7b-5e16c048d93fSymplectic Elements at OxfordLippincott, Williams and Wilkins2018Mallorie, AChan, KIoannidis, SStubbs, MNavalkissoor, SWagner, T <strong> OBJECTIVES:</strong> The risk of recurrent venous thromboembolic disease and the management of patients with isolated subsegmental pulmonary embolism (SSPE) remain unclear. We sought to assess the long-term clinical outcome of patients with isolated SSPE demonstrated by isolated subsegmental mismatch found on ventilation/perfusion (V/Q) scans. <strong>PATIENTS AND METHODS:</strong> We performed a retrospective observational study of 1300 consecutive patients with suspected pulmonary embolism who underwent index V/Q single-photon emission computed tomography between 2012 and 2013. Forty (3%) patients were found to have isolated SSPE identified on V/Q scan. Of the 40 patients with isolated SSPE on V/Q scan, 19 underwent further investigation with computed tomography pulmonary angiogram (CTPA) within 48 h. <strong>RESULTS:</strong> Among 19 patients who had corroborating CTPA performed concurrently, 94.7% of the SSPEs identified on V/Q were not detectable on CTPA. Of the 40 patients, 10 (25%) were anticoagulated. In a median follow-up of 3.28±0.55 years, all-cause mortality occurred in two patients, recurrence of suspected venous thromboembolism (VTE) occurred in 12 (30%) of 40 patients, but none had confirmed recurrent thromboembolism on further imaging. In the 40 patients with SSPE on V/Q, there was no difference in the risk of recurrence of suspected VTE or mortality between patients treated with anticoagulation and not treated (hazard ratio: 2.04, 95% confidence interval: 0.75-7.28). <strong>CONCLUSION: </strong> In this case series, a large proportion of patients with isolated SSPE on V/Q imaging were not identified on corroborating CTPA performed within 48 h. In patients with isolated SSPE (identified by isolated subsegmental mismatch on V/Q single-photon emission computed tomography), we found no difference in risk of recurrent suspected VTE or all-cause mortality in those treated with anticoagulation and those not treated. |
| spellingShingle | Mallorie, A Chan, K Ioannidis, S Stubbs, M Navalkissoor, S Wagner, T A case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imaging |
| title | A case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imaging |
| title_full | A case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imaging |
| title_fullStr | A case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imaging |
| title_full_unstemmed | A case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imaging |
| title_short | A case series of outcomes in isolated subsegmental pulmonary embolism on ventilation–perfusion imaging |
| title_sort | case series of outcomes in isolated subsegmental pulmonary embolism on ventilation perfusion imaging |
| work_keys_str_mv | AT malloriea acaseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT chank acaseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT ioannidiss acaseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT stubbsm acaseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT navalkissoors acaseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT wagnert acaseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT malloriea caseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT chank caseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT ioannidiss caseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT stubbsm caseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT navalkissoors caseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging AT wagnert caseseriesofoutcomesinisolatedsubsegmentalpulmonaryembolismonventilationperfusionimaging |