Die Lungenarterienembolie bei onkologischen Erkrankungen: Häufigkeit, Ursachen und Wahrnehmung^[*]

Zusammenfassung

Je nachdem, ob nur symptomatische Lungenarterienembolien (LAE) gewertet werden oder auch inzidentelle und initial übersehene Ereignisse, beträgt die LAE-Häufikgeit bei onkologischen Patienten 1,1 % – 7,3 %. Die LAE-Häufigkeit ist sehr tumorspezifisch. Besonders häufig sind LAE bei Tumoren des Ovars (bis zu 25 %), des Pankreas, des Gehirns, des Uterus sowie beim Multiplen Myelom zu finden. Besonders selten treten LAE bei Hodentumoren auf (< 1 %).

Die deutlich unterschiedliche Häufigkeit von LAE bei verschiedenen onkologischen Erkrankungen zeigt, dass die Assoziation von Malignomerkrankung und Tumor nicht für alle Malignome gültig ist. Eine Reihe von Argumenten, welche für diese Assoziation angeführt werden, sind auch für nicht-onkologische Patienten gültig.

Die Aufmerksamkeit des befundenden Radiologen und die Thrombusgröße bestimmen, ob eine unerwartete LAE beschrieben wird oder nicht. Insbesondere bei Malignomerkrankungen mit hoher LAE-Assoziation und bei metastasierten Tumorstadien ist eine erhöhte Aufmerksamkeit geboten.

Abstract

The frequency of pulmonary embolism (PE) in oncologic patients ranges from 1.1 % to 7.3 % depending on whether not only symptomatic findings but also incidental and initially overseen events are considered. The frequency of PE is tumor-specific. Most frequently PE occurs in patients with malignancy of the ovary (25 %), pancreas, brain, uterus, and multiple myeloma. Most rarely is PE found in patients with malignancy of the testis (< 1 %).

The tumor-specific frequency shows that the association of malignancy and PE is not equally true for alle malignancies. A number of arguments that support the above association are also valid in non-oncologic patients.

The awareness of the diagnosing radiologist and the thrombus mass decide whether or not an unexpected PE is detected. An increased awareness is suggested in patients with malignancies with high PE frequency and in patients with advanced oncologic disease.

• Literatur

• 1 Khorana AA. Malignancy, thrombosis and Trousseau: the case for an eponym. J Thromb Haemost 2003; 12: 2463-2465
• 2 Khorana AA, Francis CW, Culakova E et al. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 2007; 10: 2339-2346
• 3 Dentali F, Ageno W, Becattini C et al. Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis. Thromb Res 2010; 6: 518-522
• 4 Bach AG, Nansalmaa B, Kranz J et al. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism. Eur J Radiol 2015; 2: 332-337
• 5 O‘Connell C, Razavi P, Ghalichi M et al. Unsuspected pulmonary emboli adversely impact survival in patients with cancer undergoing routine staging multi-row detector computed tomography scanning. J Thromb Haemost 2010; 2: 305-311
• 6 Noble S, Pasi J. Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer 2010; S2-9
• 7 Heit JA, Silverstein MD, Mohr DN et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 6: 809-815
• 8 Donadini MP, Dentali F, Squizzato A et al. Unsuspected pulmonary embolism in cancer patients: a narrative review with pooled data. Internal and emergency medicine 2014; 4: 375-384
• 9 Raptopoulos V, Boiselle PM. Multi-detector row spiral CT pulmonary angiography: comparison with single-detector row spiral CT. Radiology 2001; 3: 606-613
• 10 Lewis MA. Multislice CT: opportunities and challenges. Br J Radiol 2001; 885: 779-781
• 11 Storto ML, Di Credico A, Guido F et al. Incidental detection of pulmonary emboli on routine MDCT of the chest. Am J Roentgenol 2005; 1: 264-267
• 12 Desai SR. Unsuspected pulmonary embolism on CT scanning: yet another headache for clinicians?. Thorax 2007; 6: 470-472
• 13 Gladish GW, Choe DH, Marom EM et al. Incidental pulmonary emboli in oncology patients: prevalence, CT evaluation, and natural history. Radiology 2006; 1: 246-255
• 14 Browne AM, Cronin CG, English C et al. Unsuspected pulmonary emboli in oncology patients undergoing routine computed tomography imaging. J Thorac Oncol 2010; 6: 798-803
• 15 Bach AG, Schmoll HJ, Beckel C et al. Pulmonary embolism in oncologic patients: frequency and embolus burden of symptomatic and unsuspected events. Acta Radiol 2014; 1: 45-53
• 16 Tiseo M, Bersanelli M, Pesenti Barili M et al. Asymptomatic pulmonary embolism in lung cancer: prevalence and analysis of clinical and radiological characteristics in 141 outpatients. Tumori 2012; 5: 594-600
• 17 McQueen AS, Scott J. CT staging of colorectal cancer: what do you find in the chest?. Clin Radiol 2012; 4: 352-358
• 18 Sebastian AJ, Paddon AJ. Clinically unsuspected pulmonary embolism – an important secondary finding in oncology CT. Clin Radiol 2006; 1: 81-85
• 19 van Es N, Bleker SM, Di Nisio M. Cancer-associated unsuspected pulmonary embolism. Thrombosis research 2014; 172-178
• 20 Bach AG, Beckel C, Schurig N et al. Imaging characteristics and embolus burden of unreported pulmonary embolism in oncologic patients. Clin Imaging 2014; 39: 237-242
• 21 Abdel-Razeq HN, Mansour AH, Ismael YM. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience. Vasc Health Risk Manag 2011; 153-158
• 22 Bach AG, Meyer HJ, Taute BM et al. The frequency of incidental pulmonary embolism in different computed tomography examinations. Br J Radiol 2015; 20150737
• 23 Falanga A, Russo L. Epidemiology, risk and outcomes of venous thromboembolism in cancer. Hamostaseologie 2012; 2: 115-125
• 24 Lee AY, Levine MN. Venous thromboembolism and cancer: risks and outcomes. Circulation 2003; 23 (Suppl 1) 17-21
• 25 Hui GC, Legasto A, Wittram C. The prevalence of symptomatic and coincidental pulmonary embolism on computed tomography. J Comput Assist Tomogr 2008; 5: 783-787
• 26 Zwicker JI, Liebman HA, Neuberg D et al. Tumor-derived tissue factor-bearing microparticles are associated with venous thromboembolic events in malignancy. Clin Cancer Res 2009; 22: 6830-6840
• 27 Palumbo JS, Talmage KE, Massari JV et al. Tumor cell-associated tissue factor and circulating hemostatic factors cooperate to increase metastatic potential through natural killer cell-dependent and -independent mechanisms. Blood 2007; 1: 133-141
• 28 Cronin CG, Lohan DG, Keane M et al. Prevalence and significance of asymptomatic venous thromboembolic disease found on oncologic staging CT. AJR Am J Roentgenol 2007; 1: 162-170
• 29 O‘Connell CL, Boswell WD, Duddalwar V et al. Unsuspected pulmonary emboli in cancer patients: clinical correlates and relevance. J Clin Oncol 2006; 30: 4928-4932
• 30 den Exter PL, Hooijer J, Dekkers OM et al. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol 2011; 17: 2405-2409
• 31 Krupinski EA. Current perspectives in medical image perception. Attention, perception & psychophysics 2010; 5: 1205-1217
• 32 Kundel HL, Nodine CF, Carmody D. Visual scanning, pattern recognition and decision-making in pulmonary nodule detection. Invest Radiol 1978; 3: 175-181