This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (72)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal

Michel Meignan, MD; Jean Rosso, MD; Hélène Gauthier, MD; Françoise Brunengo, MD; Sophie Claudel, PhD; Luc Sagnard, MD; Pascal d'Azemar, MD; Gérald Simonneau, MD; Bernard Charbonnier, MD

Arch Intern Med. 2000;160:159-164.

Background  A high frequency of asymptomatic pulmonary embolism (PE) has been reported in patients with deep venous thrombosis (DVT) in studies of a limited number of patients using varying criteria for lung scan assessment.

Objectives  To estimate the frequency of PE using systematic lung scans in a large group of outpatients with DVT and to compare the results using varying lung scan assessment criteria.

Methods  An international multicenter study comparing 2 different regimens of low-molecular-weight heparin nadroparin in DVT: perfusion lung scans were performed in 622 outpatients with no clinical indication of PE and with proximal DVT confirmed by venography. Three hundred seventy-nine of these patients underwent ventilation lung scans. High-probability (HP) scans for PE were assessed separately using either ventilation scans or chest radiographs to define mismatched perfusion defects.

Results  Perfusion scans showed abnormalities in 82% of the patients; 59% had segmental defects and 30% had normal scans or scans with a very low probability of PE. Depending on the criteria used, 32% to 45% had HP scans for PE; these percentages were higher in young patients. No relationship was found between extent of thrombosis and HP scans. The estimated frequency of silent PE was 39.5% to 49.5%. During a 3-month follow-up period during which the patients received therapy, the rate of PE recurrence was low (1.3%) and did not differ between patients with baseline HP scans and those with normal scans.

Conclusions  Regardless of what interpretative criteria are used for assessing lung scans in PE, the frequency of silent PE is 40% to 50% in patients with DVT. A baseline lung scan may easily detect PE in these patients but is not useful for predicting early thromboembolic recurrences that may occur during therapy.

From the Department of Nuclear Medicine, Henri Mondor Hospital, Créteil (Drs Meignan, Rosso and Gauthier); Sanofi-Recherche, Paris (Drs Brunengo, Claudel, Sagnard, and d'Azemar); the Department of Pneumology, Antoine Béclère Hospital, Clamart (Dr Simonneau); and the Department of Cardiology, Trousseau Hospital, Tours (Dr Charbonnier), France.

RELATED ARTICLES

Silent Pulmonary Embolism
Paul D. Stein
Arch Intern Med. 2000;160(2):145-146.
EXTRACT | FULL TEXT  

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(2):245-246.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Initial management of deep venous thrombosis in the outpatient setting
Groce
Am J Health Syst Pharm 2008;65:866-874.
FULL TEXT  

Ulnar Deep Venous Thrombosis in a Professional Baseball Pitcher: A Case Report
Hurbanek et al.
Am J Sports Med 2007;35:2131-2134.
FULL TEXT  

Early discharge of patients with pulmonary embolism: a two-phase observational study
Davies et al.
Eur Respir J 2007;30:708-714.
ABSTRACT | FULL TEXT  

Incidence and Prevalence of Chronic Thromboembolic Pulmonary Hypertension: From Acute to Chronic Pulmonary Embolism
Tapson and Humbert
Proc Am Thorac Soc 2006;3:564-567.
ABSTRACT | FULL TEXT  

Controversies, Uncertainties and Future Research on the Treatment of Chronic Thromboembolic Pulmonary Hypertension
Peacock et al.
Proc Am Thorac Soc 2006;3:608-614.
ABSTRACT | FULL TEXT  

Assessment of total thrombus load in symptomatic patients with venous thromboembolism.
Parakh et al.
CLIN APPL THROMB HEMOST 2006;12:369-372.
ABSTRACT  

Frequency and timing of clinical venous thromboembolism after major joint surgery
Bjornara et al.
J Bone Joint Surg Br 2006;88-B:386-391.
ABSTRACT | FULL TEXT  

Splenectomy and chronic thromboembolic pulmonary hypertension
Jais et al.
Thorax 2005;60:1031-1034.
ABSTRACT | FULL TEXT  

The Effect of Single-Detector CT Versus MDCT on Clinical Outcomes in Patients with Suspected Acute Pulmonary Embolism and Negative Results on CT Pulmonary Angiography
Prologo et al.
Am. J. Roentgenol. 2005;184:1231-1235.
ABSTRACT | FULL TEXT  

Incidental Detection of Pulmonary Emboli on Routine MDCT of the Chest
Storto et al.
Am. J. Roentgenol. 2005;184:264-267.
ABSTRACT | FULL TEXT  

A Silent Killer--Often Preventable
Futterman and Lemberg
Am J Crit Care 2004;13:431-436.
FULL TEXT  

Cost-effectiveness of Ultrasound in Preventing Femoral Venous Catheter-associated Pulmonary Embolism
Cox et al.
Am. J. Respir. Crit. Care Med. 2003;168:1481-1487.
ABSTRACT | FULL TEXT  

The D-Dimer Test for Deep Venous Thrombosis: Gold Standards and Bias in Negative Predictive Value
Philbrick and Heim
Clin. Chem. 2003;49:570-574.
ABSTRACT | FULL TEXT  

Lung Ventilation/Perfusion SPECT: The Right Technique for Hard Times
Meignan
JNM 2002;43:648-651.
FULL TEXT  

Chronic Thromboembolic Pulmonary Hypertension
Fedullo et al.
NEJM 2001;345:1465-1472.
FULL TEXT  

Diagnosis of Pulmonary Embolism in Patients with Proximal Deep Vein Thrombosis . Specificity of Symptoms and Perfusion Defects at Baseline and during Anticoagulant Therapy
GIRARD et al.
Am. J. Respir. Crit. Care Med. 2001;164:1033-1037.
ABSTRACT | FULL TEXT  

Venous Thromboembolism After Acute Stroke Response
Sandercock et al.
Stroke 2001;32 :1443-1448.
FULL TEXT  

Venous Thromboembolism After Acute Stroke
Kelly et al.
Stroke 2001;32:262-267.
ABSTRACT | FULL TEXT  

Silent Pulmonary Embolism
Egermayer
Arch Intern Med 2000;160:2218-2218.
FULL TEXT  

Silent Pulmonary Embolism
Stein
Arch Intern Med 2000;160:145-146.
FULL TEXT