Importance of subsegmental pulmonary embolism.

摘要

Pulmonary embolism (PE) causes 100 000 or more deaths each year in the United States and is the primary diagnosis or a complicating condition in more than 300 000 patient hospitalizations. The diagnosis of PE has been revolutionized with the introduction of advanced computed tomographic pulmonary angiography (CTPA). The multi-row detector CTPA is highly sensitive and specific for PE, including the relatively smaller emboli confined to subsegmental pulmonary arteries. Consequently, the proportion of all emboli diagnosed in symptomatic patients that are confined to subsegmental arteries has increased from 4.7% with the single detector to 15% with multi-row detector CTPA. A recent systematic review has suggested that this improved detection of subsegmental PE represents overdiagnosis of relatively unimportant emboli for which the risks of anticoagulant therapy may not be warranted.