Subsegmental Pulmonary Embolism

 

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Abstract

Subsegmental pulmonary embolism (SSPE) is increasingly diagnosed with the growing use and technological advancements of multidetector computed tomography pulmonary angiography. Its diagnosis is challenging, and some presumed SSPE may actually represent imaging artifacts. Indirect evidence and results from small observational studies suggest that SSPE may be more benign than more proximal pulmonary embolism, and may thus not always require treatment. Therefore, guidelines suggest to consider a management strategy without anticoagulation in selected patients with SSPE at low risk of recurrent venous thromboembolism (VTE), in whom proximal deep vein thrombosis is excluded. Recently, a large prospective study among low-risk patients with SSPE who were left untreated showed a higher VTE recurrence risk than initially deemed acceptable by the investigators, and thus was prematurely interrupted after recruitment of 97% of the target population. However, the risk–benefit ratio of anticoagulation for low-risk patients with SSPE remains unclear, and results from randomized trials are needed to answer the question about their optimal management.

Zusammenfassung

Aufgrund der zunehmenden Anwendung und technischen Weiterentwicklung von CT-Angiographien steigt die Inzidenz der subsegmentalen Lungenembolien (SSLE). Ihre Diagnose kann herausfordernd sein, denn die Unterscheidung zwischen wirklichen Perfusionsdefiziten und Artefakten ist nicht immer klar. Indirekte Evidenz und Resultate von kleinen Beobachtungsstudien sind hinweisend auf einen gutartigeren Verlauf von SSLE im Vergleich zu proximaleren LE und werfen die Frage auf, ob SSLE immer einer Therapie bedürfen. Richtlinien empfehlen die Evaluation einer Behandlungsstrategie ohne Antikoagulation bei ausgewählten Patienten mit SSLE und einem tiefen Risiko für Thromboembolierezidive nach Ausschluss einer tiefen Beinvenenthrombose. Kürzlich wurden die Resultate der bisher grössten prospektiven Studie zu Tiefrisikopatienten mit SSLE ohne Antikoagulationstherapie publiziert: das Risiko für Thromboembolierezidive war höher als initial von den Autoren als akzeptabel definiert, weshalb die Studie nach Einschluss von 97% der geplanten Studienpopulation vorzeitig abgebrochen wurde. Das Nutzen-Risiko-Verhältnis einer Antikoagulationstherapie bei Tiefrisikopatienten mit SSLE bleibt jedoch weiterhin unklar, und es braucht Resultate von randomisierten Studien, um die optimale Behandlung dieser Patienten zu definieren.

Publication History

Received: 30 April 2023

Accepted: 30 August 2023

Article published online:
23 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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