BACKGROUND: The clinical relevance of emboli limited to the segmental or sub-segmental pulmonary arteries and the role of anticoagulation in patients with these conditions remains to be clarified. OBJECTIVES: To determine the clinical characteristics and treatment outcomes of peripheral pulmonary embolism (PE), and in particular, isolated sub-segmental PE (ISSPE). METHODS: We reviewed the data for 334 patients who were diagnosed with a PE by computed tomographic (CT) pulmonary angiography and indirect CT venography. RESULTS: All patients were classified into one of three groups: central (245 patients, 73.4%); segmental (67 patients, 20.1%), and sub-segmental (22 patients, 6.6%). An incidental CT finding (63.6%) was the most common presentation in the segmental and sub-segmental groups. Compared with the central group, the sub-segmental group had less frequent proximal deep venous thrombosis (14 vs. 47%, Bonferroni's corrected p = 0.002), and greater preservation of oxygenation levels (p < 0.05) without hemodynamic instability. The recurrence of PE and deaths related to PE did not occur in the sub-segmental group, although approximately 30% of the patients did not receive anticoagulation therapy. CONCLUSIONS: Patients with ISSPE may have a more benign clinical presentation, as compared to the central type, and may follow a good clinical course without mortality or recurrence.
BACKGROUND: The clinical relevance of emboli limited to the segmental or sub-segmental pulmonary arteries and the role of anticoagulation in patients with these conditions remains to be clarified. OBJECTIVES: To determine the clinical characteristics and treatment outcomes of peripheral pulmonary embolism (PE), and in particular, isolated sub-segmental PE (ISSPE). METHODS: We reviewed the data for 334 patients who were diagnosed with a PE by computed tomographic (CT) pulmonary angiography and indirect CT venography. RESULTS: All patients were classified into one of three groups: central (245 patients, 73.4%); segmental (67 patients, 20.1%), and sub-segmental (22 patients, 6.6%). An incidental CT finding (63.6%) was the most common presentation in the segmental and sub-segmental groups. Compared with the central group, the sub-segmental group had less frequent proximal deep venous thrombosis (14 vs. 47%, Bonferroni's corrected p = 0.002), and greater preservation of oxygenation levels (p < 0.05) without hemodynamic instability. The recurrence of PE and deaths related to PE did not occur in the sub-segmental group, although approximately 30% of the patients did not receive anticoagulation therapy. CONCLUSIONS:Patients with ISSPE may have a more benign clinical presentation, as compared to the central type, and may follow a good clinical course without mortality or recurrence.
Authors: Samah I Abohamr; Mubarak A Aldossari; Hala A Amer; Hiba M Saadeddin; Sara W Abulhamid; Fayaz A Bhat; Eman Elsheikh Journal: J Saudi Heart Assoc Date: 2020-05-06