Computed tomography localization of thrombus in pulmonary thrombembolism patients and the prognostic role

Introduction: For normotensive patients with acute pulmonary thromboembolism (APE), the main predictors of mortality are PESI or sPESI score along with biological and imagistic parameters. Contrast computed tomography (CT) has become the first choice in di-agnosing this pathology. In addition to the dilatation of right heart chambers, the role of other CT parame-ters such as the central location of the thrombus in risk stratification remains a subject of controversy, with an inconsistent association with short-term mortality.
Methods: We prospectively analyzed 91 normotensive patients hospitalized between January 2014 and May 2018 with the diagnosis of APE confirmed by CT scan. Depending on the location of the thrombus, the pati-ents were divided into two groups with: central APE (thrombus at the level of trunck and main branches of the pulmonary artery, including lobar arteries) or distal (segmental or subsegmental). The patients were evalua-ted clinically, biologically and imagistically throughout the hospitalization period.
Results: The mean age of the analyzed population was 67±13.3 years, of which 61.5% were females and the in-hospital mortality was 15.4%. The central APE popula-tion did not differ in age or onset symptoms, although a shorter duration was observed from the onset of the symptoms to the time of presentation but with no statistical significance. There were no differences in the presence of typical electrocardiographic changes for APE between the two groups, including atrial fibrilla-tion. The groups did not differ in the PESI score, and the central location was not associated with higher in-hospital mortality (p=0.9). The troponin in the central APE group recorded a higher value but with no statis-tical significance. There were no differences in echocar-diographic measurements as well. Deep vein throm-bosis was recorded in 42.9% of patients and was not correlated with central thrombus location in thoracic CT, even if it was bilateral or proximal. The duration of hospitalization was higher for patients with central APE (12.2 vs. 8. 6 days, p=0.05).
Conclusions: The central location of the thrombus at CT scan has not been associated with increased in-ho-spital mortality or other predictors of short term ad-verse events. The simple location of the thrombus does not seem to provide additional advantages than using the PESI score for predicting mortality. An integrated imaging system that quantifies also the presence of ma-lignant lesions or interstitial lung disease may be able to improve the risk stratification process.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)