Online citations, reference lists, and bibliographies.
← Back to Search

Prevalence And Significance Of Asymptomatic Venous Thromboembolic Disease Found On Oncologic Staging CT.

C. Cronin, D. Lohan, M. Keane, Clare Roche, J. Murphy
Published 2007 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
OBJECTIVE The purpose of our study was to determine the prevalence of unsuspected venous thromboembolic disease--specifically, of pulmonary embolism (PE) and of inferior vena cava (IVC), iliac, and iliofemoral deep venous thromboses (DVTs)--in oncology patients on staging CT scans of the thorax, abdomen, and pelvis. MATERIALS AND METHODS Retrospective analysis was performed on 435 consecutive staging CT thorax, abdomen, and pelvis scans performed on a variety of oncology patients for the presence of venous thromboembolic disease. The patient group consisted of 198 men and 237 women who ranged in age from 20 to 79 years (mean, 55 years). Disease type, stage, concomitant surgery or chemoradiation therapy regimes, anticoagulation status, and 6-month clinical and radiologic follow-up findings were recorded. RESULTS We found a prevalence of 6.8% (23/339) unsuspected iliofemoral, 1.2% (4/339) unsuspected common iliac, and 0.3% (1/315) unsuspected IVC DVTs and 3.3% (13/397) unsuspected PEs occurring in patients with a wide range of malignancies. The overall prevalence of unsuspected venous thromboembolism (i.e., DVT, PE, or both) was 6.3% (25/397). DVT, PE, and venous thromboembolic disease were more common in inpatients (p = 0.002, 0.004, 0.023; relative risk [RR] = 1.6, 2.1, 1.4, respectively) and in those with advanced disease (p = 0.001, 0.01, 0.001; RR = 2.2, 1.8, 2.0, respectively). CONCLUSION Although there is a known increased risk of thromboembolism (DVT and PE) in oncology patients, many cases are not diagnosed, which can prove fatal. Staging CT simultaneously affords one sole investigation of the pulmonary, IVC, iliac, and upper femoral veins, thereby providing an important diagnostic opportunity. Assessment for DVT and PE is important when reviewing staging CT scans.
This paper references
10.1093/AJHP/60.SUPPL_7.S3
Venous thromboembolism: pathophysiology and clinical presentation.
S. Haines (2003)
10.1016/J.CULT.2008.01.008
Sonography of Upper Extremity Deep Venous Thrombosis
B. Madrazo (2008)
10.1001/ARCHINTE.158.6.585
Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.
M. Silverstein (1998)
10.1378/CHEST.95.3.498
Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis.
M. Huisman (1989)
10.1161/01.CIR.0000078466.72504.AC
Venous Thromboembolism and Cancer: Risks and Outcomes
A. Lee (2003)
10.2214/AJR.178.6.1781465
Pitfalls in CT venography of lower limbs and abdominal veins.
B. Ghaye (2002)
10.1148/RADIOL.2232010913
Risk of pulmonary embolism after a negative spiral CT angiogram in patients with pulmonary disease: 1-year clinical follow-up study.
I. Tillie-Leblond (2002)
10.1016/0002-9149(94)90502-9
Spiral-computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism.
A. Blum (1994)
10.1007/s00330-002-1506-z
Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years
B. Ghaye (2002)
10.1378/CHEST.120.3.791
Clinical suspicion of fatal pulmonary embolism.
L. Pineda (2001)
10.1148/RADIOLOGY.201.1.8816515
Incidental pulmonary emboli detected at helical CT: effect on patient care.
C. Winston (1996)
10.1148/RADIOL.2392050118
Pulmonary embolism at multi-detector row CT of chest: one-year survival of treated and untreated patients.
C. Engelke (2006)
10.1056/NEJM199205073261902
The clinical course of pulmonary embolism.
J. Carson (1992)
10.1016/J.CRAD.2005.09.002
Clinically unsuspected pulmonary embolism—an important secondary finding in oncology CT
A. J. Sebastian (2006)
10.2214/AJR.184.1.01840264
Incidental detection of pulmonary emboli on routine MDCT of the chest.
M. Storto (2005)
10.1148/RADIOLOGY.208.1.9646815
Unsuspected pulmonary embolism: prospective detection on routine helical CT scans.
M. Gosselin (1998)
10.1056/NEJM200012213432504
Prognosis of cancers associated with venous thromboembolism.
H. Sørensen (2000)
10.1007/s00330-005-2844-4
Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism
S. Brunot (2005)
10.1378/CHEST.122.4.1440
Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology, and diagnosis.
J. Dalen (2002)
10.4065/73.9.873
Clinical recognition of pulmonary embolism: problem of unrecognized and asymptomatic cases.
J. Ryu (1998)
10.1046/j.1365-2796.1997.74880000.x
The clinical significance of pulmonary embolism: uncertainties and implications for treatment – a debate
P. Egermayer (1997)
10.1148/RADIOL.2401051129
Incidental pulmonary emboli in oncology patients: prevalence, CT evaluation, and natural history.
G. Gladish (2006)
10.1148/RADIOLOGY.200.3.8756918
Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy.
M. Rémy-Jardin (1996)
10.1148/RADIOLOGY.185.2.1410342
Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique--comparison with pulmonary angiography.
M. Remy-Jardin (1992)
10.1097/01.TA.0000119687.23542.EC
Incidence of asymptomatic pulmonary embolism in moderately to severely injured trauma patients.
D. J. Schultz (2004)
10.2214/AJR.184.2.01840623
Clinicians' response to radiologists' reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT.
B. A. Eyer (2005)
10.1016/S0196-0644(87)80544-9
Occult pulmonary embolism: A common occurrence in deep venous thrombosis: Dorfman GS, Cronan JJ, Tupper TB, et al AJR 148:263–266 Feb 1987
S. Whiteley (1987)
10.2214/AJR.148.2.263
Occult pulmonary embolism: a common occurrence in deep venous thrombosis.
G. Dorfman (1987)
10.1111/j.1538-7836.2005.01393.x
Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study
C. Seinturier (2005)
10.1016/j.ejon.2008.08.001
A review of the practical advantages of low molecular weight heparin in the treatment of cancer-related venous thromboembolism.
S. Rhodes (2008)
10.1056/NEJM198212303072704
Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis.
R. Hull (1982)
10.2214/AJR.176.5.1761281
Combined CT venography and pulmonary angiography: how much venous enhancement is routinely obtained?
D. Bruce (2001)
10.7326/0003-4819-125-1-199607010-00001
The Long-Term Clinical Course of Acute Deep Venous Thrombosis
P. Prandoni (1996)
10.1161/01.CIR.0000046072.10311.41
Thromboembolism in Real-Time Two-Dimensional Echocardiography
G. Davis (2003)
10.1056/NEJM199804233381701
The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism.
H. Sørensen (1998)
10.2214/AJR.07.3516
Venous thromboembolism and occult malignancy: simultaneous detection during pulmonary CT angiography with CT venography.
G. Bierry (2008)
10.1161/01.CIR.0000078468.11849.66
The Epidemiology of Venous Thromboembolism
R. White (2003)
10.1016/S0196-0644(89)80026-5
Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis: Huisman MV, Buller HR, ten Cate JW, et al Chest 95:498–502 Mar 1989
G. Bennett (1989)
10.1056/NEJM198201283060401
Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis.
R. Hull (1982)



This paper is referenced by
Thoracic vascular disease in oncology patients
María Simonet Redondo (2010)
10.1080/07357900802656681
Venous Thromboembolism (VTE) in Patients with Cancer: Epidemiology and Risk Factors
T. Wun (2009)
Levels of Natural Anticoagulants Protein C, Protein S and Antithrombin III in Patients with Solid Malignancies
Masooma Raza (2014)
10.1093/annonc/mdq720
Incidental versus symptomatic venous thrombosis in cancer: a prospective observational study of 340 consecutive patients.
C. Font (2011)
10.1016/j.thromres.2010.02.010
Incidental venous thromboembolism in cancer patients: prevalence and consequence.
R. Douma (2010)
10.1111/j.1749-6632.2011.06082.x
Future and upcoming non‐neoplastic applications of PET/CT imaging
M. Hashefi (2011)
10.1016/j.jss.2016.06.089
The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery.
G. Bellini (2016)
10.2147/VHRM.S2132
Management of venous thromboembolism in patients with cancer: role of dalteparin
L. Linkins (2008)
10.1002/cncr.25941
Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center
A. Shinagare (2011)
10.1136/pgmj.2011.118497
The clinician's response to a report of an incidental pulmonary embolism detected on multidetector CT
J. Franklin (2011)
10.1016/B978-1-4557-2296-9.00023-3
Thrombosis and Cancer
G. Connolly (2013)
10.1183/13993003.00275-2017
Management of incidental pulmonary embolism
F. Klok (2017)
10.1007/s11239-011-0562-0
Anticoagulation in the management of venous thromboembolism in the cancer patient
M. Streiff (2011)
10.1016/j.cllc.2013.06.003
Prevalence and clinical significance of incidental and clinically suspected venous thromboembolism in lung cancer patients.
G. Connolly (2013)
10.1007/s00117-017-0226-y
Klinisch relevante kardiovaskuläre Zufallsbefunde bei CT‑Untersuchungen
P. Voigt (2017)
10.1016/j.ejim.2011.11.005
Venous thromboembolism prophylaxis of acutely ill hospitalized medical patients. Are we under-treating our patients?
Batia Roth-Yelinek (2012)
10.1007/978-3-540-35280-8_2641
Venous Thromboembolic Disease
Jessica Lee Weber (2014)
10.1111/j.1538-7836.2010.03929.x
High rates of symptomatic and incidental thromboembolic events in gastrointestinal cancer patients
R. Singh (2010)
10.1097/JTO.0b013e3181d6153a
Unsuspected Pulmonary Emboli in Oncology Patients Undergoing Routine Computed Tomography Imaging
A. Browne (2010)
10.1177/030089161209800509
Asymptomatic Pulmonary Embolism in Lung Cancer: Prevalence and Analysis of Clinical and Radiological Characteristics in 141 Outpatients
M. Tiseo (2012)
10.1093/annonc/mdq012
D-dimer level as a risk factor for postoperative venous thromboembolism in Japanese women with gynecologic cancer.
J. Kodama (2010)
10.1016/j.jss.2012.12.016
Nomograms to predict risk of in-hospital and post-discharge venous thromboembolism after abdominal and thoracic surgery: an American College of Surgeons National Surgical Quality Improvement Program analysis.
Dhruvil R. Shah (2013)
10.1111/bjh.13556
Guideline on aspects of cancer‐related venous thrombosis
H. Watson (2015)
10.15386/cjmed-931
Incidental findings during follow-up scans in oncological patients
C. Caraiani (2018)
Hallazgo casual de complicaciones vasculares en el paciente oncológico, más allá del tromboembolismo pulmonar.
M. D. P. Robles (2012)
10.1007/s11739-010-0445-y
The treatment of venous thromboembolism in patients with cancer
P. Prandoni (2010)
10.1007/s11739-014-1066-7
Unsuspected pulmonary embolism in cancer patients: a narrative review with pooled data
Marco Paolo Donadini (2014)
10.1177/1049909110361244
Review Article: Role of Palliative Low-Molecular-Weight Heparin for Treating Venous Thromboembolism in Patients With Advanced Cancer
Quy N H Tran (2010)
10.1016/j.thromres.2012.07.006
Unsuspected visceral venous thrombosis, in patients with cancer of the gastrointestinal system.
G. Bozas (2012)
10.4999/UHOD.171662
Prognostic Effect of Symptomatic and Asymptomatic Venous Thromboembolism in Patients with Gastric Cancer
Y. Bozkaya (2017)
3 Delays in the Diagnosis of Pulmonary Thromboembolism and Risk Factors
S. Ozsu (2012)
10.1038/sj.bjc.6605091
Does clinical method mask significant VTE-related mortality and morbidity in malignant disease?
A. Maraveyas (2009)
See more
Semantic Scholar Logo Some data provided by SemanticScholar