| Dots are not clots: the over-diagnosis and over-treatment of PE. | |
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MedLine Citation:
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PMID: 20217446 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The purpose of this work is to question the conventional theory that all pulmonary emboli (PE) are abnormal, and to test the hypothesis that small peripheral PE are a function of life. Most radiologists report any filling defect, independent of size, as clinically significant PE when detected in the pulmonary arteries. We sought to reinforce the theory that small dots in the pulmonary arteries are not clinically significant clots in the conventional setting. The necessity for anticoagulation should be balanced against the risk of bleeding. This retrospective HIPAA-compliant study was approved by the institutional review board; informed consent was not required. All patients diagnosed with PE by 16-slice or 64-slice multidetector computed tomography (CT) over a 6-month period who also had a lower extremity venous ultrasound (US) performed within 7 days of CT were identified. The study group included 26 women and 24 men (mean, 56 years; range, 21-90 years). The locations of the PE were plotted on a pulmonary arterial diagram, and width of the most proximal clot for each patient was measured. Of 1,273 consecutive CT studies, 101 were positive (7.9%) and 50 patients underwent lower extremity US. Thirty-three (66%) patients had PE in the central pulmonary arteries, of which 19 (58%) had deep vein thrombosis (DVT). Seventeen (34%) patients had peripheral PE; DVT was detected in 0 (0%) patients. The peripheral clots measured 1.0-3.8 mm (mean, 2.5 mm). These clots appeared focal and rounded with a "dot-like" appearance. Peripheral, focal filling defects in the pulmonary arteries, which we termed "dots," are not traditional embolic clots, are not associated with detectable lower-extremity clot load, and may represent "normal" embolic activity originating from the lower extremity venous valves. We suggest that more in-depth understanding about small peripheral PE is needed. The necessity of conventional anticoagulation should be critically reviewed in patients with subsegmental PE and minimal clot burden. |
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Authors:
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Jane M Suh; John J Cronan; Terrance T Healey |
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Publication Detail:
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Type: Journal Article Date: 2010-03-09 |
Journal Detail:
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Title: Emergency radiology Volume: 17 ISSN: 1438-1435 ISO Abbreviation: Emerg Radiol Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-03 Completed Date: 2010-12-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9431227 Medline TA: Emerg Radiol Country: United States |
Other Details:
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Languages: eng Pagination: 347-52 Citation Subset: IM |
Affiliation:
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Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over False Positive Reactions Female Humans Male Middle Aged Pulmonary Embolism / diagnosis, radiography*, therapy Retrospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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