How I treat incidental pulmonary embolism

The identification of pulmonary embolism (PE) on computed tomography scans performed for indications other than identification of thromboembolism is a growing clinical problem that has not been adequately addressed by prospective treatment trials. The prevalence of incidentally detected PE ranges from 1% to 4% in unselected populations, with higher rates among hospital inpatients and patients with cancer. Current guidelines recommend using the same approach to type and duration of anticoagulation as is used for patients with suspected PE. Available data regarding the significance of symptomatic subsegmental PE (SSPE) are conflicting, making it difficult to draw conclusions about the appropriate treatment of incidentally detected SSPE, for which the data are sparse. Among cancer patients, the bulk of available data suggest that incidental SSPE is associated with recurrent venous thromboembolism and, when symptomatic, may adversely impact survival. Here, the topic is reviewed utilizing 3 clinical cases, each of which is followed by a discussion of salient features and then by treatment recommendations.