Carneiro Renata Mota, van Bellen Bonno, Santana Pablo Rydz Pinheiro, Gomes Antônio Carlos Portugal
Hospital Beneficência Portuguesa de São Paulo - BP, Serviço de Cirurgia Vascular, São Paulo, SP, Brasil.
Hospital Beneficência Portuguesa de São Paulo - BP, Serviço de Radiologia, São Paulo, SP, Brasil.
J Vasc Bras. 2017 Jul-Sep;16(3):232-238. doi: 10.1590/1677-5449.002117.
Increased use of routine imaging exams has led to higher rates of incidental diagnosis of pulmonary thromboembolism (PTE), especially for management of disease in cancer patients, among whom it is an important factor in associated morbidity and mortality.
To identify cases of incidental PTE in cancer patients examined with computed tomography (CT) of the thorax, correlating clinical features and associated risk factors.
This is a retrospective study of all episodes of PTE diagnosed between January 2013 and June 2016, selecting cases involving cancer patients and dividing them into two subsets: those with clinical suspicion and those without clinical suspicion of pulmonary embolism (incidental cases).
At total of 468 patients had PTE during the period investigated and 23.1% of them were cancer patients, 44.4% of whom exhibited pulmonary embolism as an incidental finding of a chest CT. There was no statistical difference between the two subsets in terms of sex, age, or smoking. In terms of patients’ admission status, 58.3% of the patients without clinical suspicion were outpatients and 41.7% of those with suspicion of PTE were admitted via the emergency room (p < 0.001). The most common cancer sites were lung (17.6%), intestine (15.7%), and breast (13.0%). Patients whose PTE were diagnosed incidentally exhibited a significantly greater rate of metastases, while there were no differences between the groups in terms of chemotherapy, radiotherapy, or recent surgery. Analysis of symptoms revealed that 41.9% of patients without clinical suspicion had complaints suggestive of PTE when they underwent the CT examination.
Incidental PTE is common among cancer patients, especially those in outpatients follow-up and in advanced stages of the disease. Patients without clinical suspicion also had symptoms suggestive of PTE when they presented for chest CT.
常规影像学检查的使用增加导致肺血栓栓塞症（PTE）的偶然诊断率升高，尤其是在癌症患者的疾病管理中，PTE是相关发病率和死亡率的一个重要因素。
识别接受胸部计算机断层扫描（CT）检查的癌症患者中的偶然PTE病例，将临床特征与相关危险因素进行关联。
这是一项对2013年1月至2016年6月期间诊断的所有PTE发作进行的回顾性研究，选择涉及癌症患者的病例并将其分为两个亚组：有临床怀疑的患者和无临床怀疑肺栓塞的患者（偶然病例）。
在研究期间共有468例患者发生PTE，其中23.1%为癌症患者，其中44.4%的患者肺栓塞是胸部CT的偶然发现。两个亚组在性别、年龄或吸烟方面无统计学差异。就患者的入院状态而言，无临床怀疑的患者中有58.3%为门诊患者，怀疑PTE的患者中有41.7%通过急诊室入院（p<0.001）。最常见的癌症部位是肺（17.6%）、肠道（15.7%）和乳腺（13.0%）。偶然诊断出PTE的患者转移率显著更高，而两组在化疗、放疗或近期手术方面无差异。症状分析显示，无临床怀疑的患者中有41.9%在接受CT检查时出现提示PTE的症状。
偶然PTE在癌症患者中很常见，尤其是在门诊随访患者和疾病晚期患者中。无临床怀疑的患者在进行胸部CT检查时也有提示PTE的症状。
