Journal article
Prevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective cohort study
The American journal of emergency medicine, Vol.54, pp.232-237
04/2022
DOI: 10.1016/j.ajem.2022.01.064
PMID: 35182917
Abstract
The purpose of this study was to analyze the prevalence and significance of incidental findings on computed tomography pulmonary angiography (CTPA) studies and to assess the diagnostic yield of CTPA in identifying an alternate diagnosis to pulmonary embolism (PE) on PE negative exams.
All patients who had a CTPA exam for PE evaluation between Jan 2016 and Dec 2018 with a negative PE result were included in the study. A total of 2083 patients were identified. We retrospectively queried the electronic medical record and the radiology report and recorded the following: Age, Sex, BMI, Patient location and Incidental findings. The incidental findings were classified into type 1 (Alternate diagnosis other than PE which could explain the patient's symptoms), type 2 (non-emergent findings which needed further work up) and type 3 findings (non-emergent findings which did not need further work up). Logistic regression analysis was performed to determine what factors affected the probability of finding a type 1 incidental (alternate diagnosis) or a type 2 incidental.
74.5% of the patients in our study had at least one incidental finding. Type 1 incidental findings (alternate diagnosis to PE) were found in 864 patients (41.5%). The most common type 1 finding was pneumonia followed by fluid overload. Male sex, increased age and lower BMI were significantly associated with increased odds of a type 1 incidental(p < 0.05). Similarly, all the patient locations had significantly different odds of finding a type-1 incidental, with ICU having the highest odds, followed by inpatient, ED and outpatient locations (p < 0.05). 563 patients (27%) had at least one type 2 incidental findings and the most common type 2 findings were progressive lung malignancy/ metastatic disease and new pulmonary nodule. Increased age was significantly associated with the probability of a type 2 finding (p < 0.05).
CTPA may suggest an alternative diagnosis to pulmonary embolism in approximately 40% of the patients with a negative study. The probability of finding an alternate diagnosis (type 1 incidental) is higher in elderly patients and in patients referred from ICU and inpatient units.
•Incidental findings are very common and seen in 75% of CTPA studies.•CTPA may suggest an alternate diagnosis to pulmonary embolism(PE) in 40% of the patients with a negative PE study.•Yield of CTPA in finding an alternate diagnosis is higher in ICU setting and Inpatients compared to the ED.
Details
- Title: Subtitle
- Prevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective cohort study
- Creators
- Ali Eskandari - University of IowaSabarish Narayanasamy - Roy J. and Lucille A. Carver College of MedicineCaitlin Ward - University of IowaSarv Priya - University of IowaTanya Aggarwal - University of IowaJacob Elam - Roy J. and Lucille A. Carver College of MedicinePrashant Nagpal - University of Wisconsin–Madison
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.54, pp.232-237
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.ajem.2022.01.064
- PMID
- 35182917
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Language
- English
- Date published
- 04/2022
- Academic Unit
- Radiology; Nursing
- Record Identifier
- 9984318800002771
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