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Prospective Evaluation of Unsuspected Pulmonary Embolism on Coronary Computed Tomographic Angiography

Jia, Chong-Fu MMed*; Li, Yan-Xia MMed; Yang, Zhi-Qiang MMed*; Zhang, Zhong-He MD; Sun, Xi-Xia MMed*; Wang, Zhao-Qian MD*

Journal of Computer Assisted Tomography: March/April 2012 - Volume 36 - Issue 2 - p 187–190
doi: 10.1097/RCT.0b013e3182483be1
Thoracic Imaging

Objective This study aimed to analyze patients with unsuspected pulmonary embolism (PE) in coronary computed tomographic angiography (CCTA) and to draw some conclusions regarding their characteristics.

Methods All patients suspected of coronary heart disease undergoing CCTA between May 2006 and December 2010 were prospectively analyzed. Patients with previous or suspected current PE were excluded. The CCTA images were reviewed, and the degree of contrast enhancement and the presence or absence of PE were recorded. Where PE was found, the level of the most proximal thrombus was identified. Patients’ demographics were recorded.

Results Of 7287 patients, 65 had unsuspected PE—an overall incidence of 0.9% (1.3% among inpatients and 0.3% among outpatients). Unsuspected PE was more common with increasing age, occurring in 0.4% of all patients younger than 60 years and 1.2% (52/4203) of those older than 60 years (P < 0.05). Of the 65 scans positive for disease, 43 (66.2%) were at the segmental or the subsegmental level. Patients with paroxysmal atrial fibrillation (AF) or AF history and cardiac insufficiency (3.2% and 4.1%) were more likely to have an unsuspected PE compared with those without (0.7%), and this was supported by the statistics. Deep vein thrombosis of the lower extremity was found in 8 (13.1%) of 61 patients with PE and in 12 (19.4%) of 62 patients with a D-dimer level of 500 ng/mL or higher.

Conclusions Unsuspected PE was found in 0.9% of all patients undergoing CCTA, and this kind of PE has its own characteristics compared with the typical PE from the literature. Radiologists should routinely analyze the pulmonary arteries in all patients undergoing CCTA, especially for older patients and the patients with AF or AF history and cardiac insufficiency.

From the Departments of *Cardiovascular Radiology and †Respiratory Medicine, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.

Received for publication October 22, 2011; accepted December 24, 2011.

Reprints: Zhao-Qian Wang, Department of Cardiovascular Radiology, the First Affiliated Hospital of Dalian Medical University, No. 222 Zhong Shan Rd, Dalian 116011, Liaoning, China (e-mail:

The authors report no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.