Document Detail

Dots are not clots: the over-diagnosis and over-treatment of PE.
MedLine Citation:
PMID:  20217446     Owner:  NLM     Status:  MEDLINE    
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.
Jane M Suh; John J Cronan; Terrance T Healey
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Publication Detail:
Type:  Journal Article     Date:  2010-03-09
Journal Detail:
Title:  Emergency radiology     Volume:  17     ISSN:  1438-1435     ISO Abbreviation:  Emerg Radiol     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-03     Completed Date:  2010-12-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431227     Medline TA:  Emerg Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  347-52     Citation Subset:  IM    
Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA.
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MeSH Terms
Aged, 80 and over
False Positive Reactions
Middle Aged
Pulmonary Embolism / diagnosis,  radiography*,  therapy
Retrospective Studies

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