Detection of incidental pulmonary embolism with multi-slice computed tomography in cancer patients Muhammed Akif Deniz a, ⁎, Zelal Taş Deniz a , Mehmet Emin Adin b , Ferit Akıl c , Mehmet Turmak d , Zuhat Urakcı e , Mehmet Guli Cetincakmak f , Cemil Goya f a Department of Radiology, Health Science University Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey b Department of Radiology, Silvan State Hospital, Diyarbakır, Turkey c Otorhinolaryngology Clinic, Diyarbakir Selahaddin Eyyubi Public Hospital, Diyarbakir, Turkey d Department of Radiology, Bitlis State Hospital, Bitlis, Turkey e Department of Oncology, Dicle University School of Medical Science, Diyarbakir, Turkey f Department of Radiology, Dicle University School of Medical Science, Diyarbakir, Turkey abstract article info Article history: Received 5 June 2016 Received in revised form 16 October 2016 Accepted 21 October 2016 Available online xxxx The aim of this study is to show the frequency of incidentally found (pulmonary thromboembolism) PTE in on- cological patients and evaluate dispersion of incidents in terms of underlying primary tumor and seek risk factors associated with incidental PTE. Among one thousand oncology patients, 46 (4.6%) individuals found to have incidental PTE. Of positive patients, the highest proportion (24%) was belong to breast cancer group (n = 11). The most common location for pulmo- nary emboli was the lower lobe branch of right pulmonary artery (n = 33, 71.7%). Evident PTE had not been re- ported in final radiology reports of 21 cases. © 2016 Elsevier Inc. All rights reserved. Keywords: Incidentally pulmonary thromboembolism (PTE) Cancer Multislice computed tomography (MSCT) Computed tomography 1. Introduction The blockage of the pulmonary arteries can lead to wide spectrum of clinical manifestations from nonspecific symptoms to sudden death, de- pending on the location and severity of blockage [1]. Pulmonary embolism (PE) accounts for 10–15% of deaths in adults. It is the most common cause of death in bedridden patients and the second most common cause of death in hospitalized cancer cases. Moreover, it is the third most common cause of cardiovascular disease related death after coronary artery disease and stroke [2]. In patients with cancer, the risk of thrombosis is 4–6 times higher com- pared to the normal population because of immobilization, vascular obstruction, surgery, radiotherapy, chemotherapy, catheters and metastasis [3]. The mortality rate from PE in untreated patients is 30%, however early diagnosis and appropriate treatment can de- crease this rate to 3–10% [4,5]. In parallel with the recent advances in computed tomography (CT) technology, the multislice computed tomography (MSCT) has replaced ventilation/perfusion (V/Q) lung scan and pulmonary angiography in diagnosis of PE. The MSCT and MSCT angiography (MSCTA) have become crucial modalities for the diagnosis of PE because they are noninvasive, fast, and have the ability to acquire images distal to subsegmental pulmonary arterial branches. More- over, pathological findings in lung parenchyma, mediastinum, pleu- ra, and chest wall could also be appreciated on MSCT angiography (MSCTA) [6,7]. The detection of PE is relatively easy in patients with apparent clinical signs as opposed to those with subtle or no symptoms of thromboembolism. The absence of thromboembolism symptoms often goes unnoticed in contrast enhanced thoracic CT, which is usually performed for staging of the disease and monitoring the therapy response in cancer patients. The aim of this study was to determine the prevalence of inciden- tal pulmonary embolism in routine contrast enhanced thoracic CT scans in cancer patients with no particular clinical signs or prelimi- nary diagnosis of PE. We also aimed to investigate whether the loca- tion of emboli, risk factors, incidence, and radiological findings of patients with incidentally detected embolism are reported in routine examinations. 2. Materials and methods We retrospectively evaluated MSCT images of consecutive cancer patients that were scanned for a routine follow up in our Radiology Clinical Imaging 41 (2016) 106–111 ⁎ Corresponding author. E-mail address: makifdeniz@yahoo.com (M.A. Deniz). http://dx.doi.org/10.1016/j.clinimag.2016.10.018 0899-7071/© 2016 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Clinical Imaging journal homepage: http://www.clinicalimaging.org