Cross Sectional Study of Unsuspected Pulmonary Embolism in Oncology Patients Undergoing Chest Computed Tomography Imaging in Tikur Anbessa Specialized Hospital Addis Abeba University, Addis Abeba ,Ethiopia.
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Date
2019-09
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Addis Abeba University
Abstract
Background
Oncology patients have a fourfold higher risk for developing pulmonary embolism than that of the general
population. Acute pulmonary embolism (PE) is a common and often fatal disease. Furthermore, most cases of
PE that eventuallycause fatality are clinically unsuspected and therefore go untreated.
Finding of incidental PE in oncologic patients significantly affects management and prognosis of patients.
Diagnosis of PE leads to start of therapeutic anticoagulation and prevents embolic recurrence that is associated
with substantial morbidity and mortality.
A
lthough the MDCT protocol for CT pulmonary angiography differs from that used for routine chest CT,
modern CT systems, along with high-concentration contrast media, enable detection of pulmonary emboli even
in routine chest CT, increasing the frequencyof detection of clinically unsuspected pulmonary embolism.
2
Objective
This study is designed to assess prevalence of incidentalpulmonary embolism in oncologic patients detected by
chest computed tomography.
Method
Hospital based prospectivecross-sectional study conducted at TASH to address the specific objective during the
study period (July, 2018-January 2019 G.C).This study was conducted among oncologic patients being
evaluated at TikurAnbessa Specialized Hospital who have chest CT imaging during the study period. Chest CT
was evaluated for the presence of abnormalities.
The study population included all oncologic patients having chest CT imaging during the data collection period.
Data was collected by evaluating the CT by radiologist. The data was checked for clarity and completeness.
Computerized data analysis was conducted by using SPSS version 20.0 software.
RESULT
The prevalence of incidental PE was 1.7% in this study. A total of 10 patients out of 573 patients had incidental
PE. The most common primary malignancy was GIT malignancy (30.9%). The other malignancies were
hematologic malignancies among 12.9%, breast cancer in 12.6%, and cancers of the genitourinary tract in 7.7%.
the rest of patients had varieties of different cancer types.80% of the patients with PE had multiple PE and 20%
had single PE.
The most commonly involved part of the lung was RLL which was involved in all cases of incidental PE.
Followed by LLL which was involved in 60%. In general, the upper lobes and the RML were involved in 40%
of the cases, each. All cases of single PE occurred in the RLL.
3
The most frequently involved divisions of the pulmonary were the lobar branches in 80% of the PE cases
followed by segmental branches (70%). The main division was involved in 40% of the cases, while the
subsegmental division was involved in none of the cases.
Limitation of the study
-Lack of good pulmonary arterial opacification and motion artifacts which can limit detection of PE.
-Lack of properly handled patient’s chart.
-Limited sample size.
CONCLUSION
The prevalence of incidental PE detected on routine chest CT scan is 1.7% with no detected small artery PE.
The risk of incidental PE was higher in older age and advanced malignancy. The diagnosis of incidental PE has
significantly changed the management in all of these patients.
Good pulmonary arterial contrastopacificationis required for diagnosis.
Description
Keywords
Pulmonary Embolism ,Oncology Patients ,Chest ,Tomography Imaging