Research Article
BibTex RIS Cite

Incidental findings in patients who underwent computed tomography angiography with a preliminary diagnosis of pulmonary embolism

Year 2026, Volume: 8 Issue: 2, 174 - 178, 10.03.2026
https://doi.org/10.38053/acmj.1824519
https://izlik.org/JA82RD84UF

Abstract

Aims: The aim of this study was to investigate the contribution of incidental findings to the diagnosis in patients who underwent computed tomography pulmonary angiography (CTPA) with a preliminary diagnosis of pulmonary embolism (PE).
Methods: In this retrospective study, 266 patients who underwent CT imaging with the diagnosis of PE between 01.01.2025 and 08.08.2025 were evaluated. After evaluating the presence of PE, the CTA images were evaluated for incidental findings. Incidental findings were reported in three categories (Type 1: Life-threatening or requiring rapid treatment, Type 2: Findings with potential for morbidity requiring specific action on follow-up, Type 3: Benign processes of limited clinical significance).
Results: In this study, the number of patients diagnosed with PE was 27 (10.2%), while the number of patients diagnosed with bilateral PE was 7 (2.6%). Only 18 (6.8%) patients had no incidental findings. No significant difference is found in the ratio of incidental findings regarding gender (p=0.227). When we divided the incidental findings into groups, there were 90 (33.8%) patients in type 1, 124 (46.6%) patients in type 2, and 215 (80.8%) patients in type 3. The most common incidental findings were pneumonia in type 1, enlarged mediastinal lymph nodes in type 2, and fibroatelectatic changes in type 3. Particularly, the number of patients in type 1 (life-threatening or requiring rapid treatment) reveals the importance of incidental findings in patients examined with a preliminary diagnosis of PE.
Conclusion: In patients with suspected PE, CTPA may indicate an important alternative diagnosis other than PE.

Ethical Statement

Conflict of Interest The authors declare no conflict of interest related to this study. Funding This research received no external funding. Ethical Approval This study was approved by the Ethics Committee of XXXX(Approval No: 2025-10/144). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. Informed Consent Informed consent was obtained from all individual participants included in the study.

Supporting Institution

none

Thanks

Acknowledgments The authors would like to thank the staff of the Department of Radiology for their technical assistance and patient care during the study.

References

  • Bukhari S, Hunter J, Bera K, et al. Clinical and imaging aspects of pulmonary embolism: a primer for radiologists. Clin Imaging. 2025;117: 110328. doi:10.1016/j.clinimag.2024.110328
  • Konstantinides SV, Torbicki A, Agnelli G, et al. ESC guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) endorsed by the European Respiratory Society (ERS). Eur Heart J. 2014;35(43):3033-3080. doi:10.1093/eurheartj/ehu283
  • Zantonelli G, Cozzi D, Bindi A, et al. Acute pulmonary embolism: prognostic role of computed tomography pulmonary angiography (CTPA). Tomography. 2022;8(1):529-539. doi:10.3390/tomography8010042
  • Abdurrahman Koc, Hulya Vatansev. Prognostic relevance of biochemical markers integrated with simplified pulmonary embolism severity index in acute pulmonary embolism. Ann Clin Anal Med. 2025; 16(12):893-898
  • Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019;3(3):315-330. doi:10.1002/rth2.12216
  • Dronkers C, Huisman M, Klok F. Clinical presentation of acute pulmonary embolism. Handbook of Venous Thromboembolism. 2017:21-26. doi.org/10.1002/9781119095606.ch3
  • Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-243. doi:10.21037/cdt.2017.12.01
  • Mamlouk MD, van Sonnenberg E, Gosalia R, et al. Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology. 2010;256:625-632. doi:10.1148/radiol.10091624
  • Zaw A, Nguyen R, Lam L, Kaplan A, Dobler CC. Effect of limiting the scan range of computed tomography pulmonary angiography (to reduce radiation exposure) on the detection of pulmonary embolism: a systematic review. Diagnostics. 2021;11(12):2179. doi:10.3390/diagnostics11122179
  • Tao SM, Wichmann JL, Schoepf UJ, Fuller SR, Lu GM, Zhang LJ. Contrast-induced nephropathy in CT: incidence, risk factors, and strategies for prevention. Eur Radiol. 2016;26(9):3310-3318. doi:10.1007/s00330-015-4155-8
  • Cereser L, Bagatto D, Girometti R, Como G, Zuiani C, Bazzocchi M. Chest multidetector computed tomography in patients with suspected acute pulmonary embolism: diagnostic yield and proportion of other clinically relevant findings. Radiol Med. 2011;116:219-229. doi:10.1007/s11547-010-0612-2
  • Aggarwal T, Eskandari A, Priya S, et al. Pulmonary embolism rule-out: positivity and factors affecting the yield of CT angiography. Postgrad Med J. 2020;96.
  • Costantino MM, Randall G, Gosselin M, Brandt M, Spinning K, Vegas CD. CT angiography in the evaluation of acute pulmonary embolus. AJR Am J Roentgenol. 2008;191(2):471-474. doi:10.2214/AJR.07.2552
  • Costa AF, Basseri H, Sheikh A, Stiell I, Dennie C. The yield of CT pulmonary angiograms to exclude acute pulmonary embolism. Emerg Radiol. 2014;21(2):133-141. doi:10.1007/s10140-013-1169-x
  • Perelas A, Dimou A, Saenz A, et al. Incidental findings on computed tomography angiography in patients evaluated for pulmonary embolism. Ann Am Thorac Soc. 2015;12(5):689-695. doi:10.1513/AnnalsATS.201404-144OC
  • Korkut M, Bedel C, Erman K, Yüksel S. Incidental findings of computed tomography angiography in patients suspected to have pulmonary embolism: a brief report. Arch Acad Emerg Med. 2019;7(1):e60.
  • Champion N, Hogan S, Flemming J. Assessing the prevalence of incidental findings identified by CTPA in women of reproductive age. Emerg Med Int. 2018;2018:1-5.
  • Jung JI, Kim KJ, Ahn MI, et al. Detection of pulmonary embolism using 64-slice multidetector-row computed tomography: accuracy and reproducibility on different image reconstruction parameters. Acta Radiol. 2011;52(4):417-421. doi:10.1258/ar.2011.100217

Pulmoner emboli ön tanısıyla bilgisayarlı tomografi anjiyografisi yapılan hastalarda rastlantısal bulgular

Year 2026, Volume: 8 Issue: 2, 174 - 178, 10.03.2026
https://doi.org/10.38053/acmj.1824519
https://izlik.org/JA82RD84UF

Abstract

Amaçlar: Bu çalışmanın amacı, pulmoner emboli (PE) ön tanısıyla bilgisayarlı tomografi pulmoner anjiyografi (BTPA) uygulanan hastalarda tesadüfi bulguların tanıya katkısını araştırmaktır.
Yöntemler: Bu retrospektif çalışmada, 01.01.2025 ile 08.08.2025 tarihleri arasında PE tanısıyla BT görüntülemesi yapılan 266 hasta değerlendirildi. PE varlığı değerlendirildikten sonra, BTTA görüntüleri tesadüfi bulgular açısından değerlendirildi. Tesadüfi bulgular üç kategoride rapor edildi (Tip 1: Hayatı tehdit eden veya hızlı tedavi gerektiren, Tip 2: Takipte spesifik müdahale gerektiren morbidite potansiyeli olan bulgular, Tip 3: Sınırlı klinik öneme sahip iyi huylu süreçler).
Bulgular: Bu çalışmada PE tanısı alan hasta sayısı 27 (%10,2) iken, bilateral PE tanısı alan hasta sayısı 7 (%2,6) idi. Sadece 18 (%6,8) hastada rastlantısal bulgu yoktu. Cinsiyete göre rastlantısal bulgu oranında anlamlı fark bulunmadı (p=0,227). Rastlantısal bulguları gruplara ayırdığımızda, tip 1'de 90 (%33,8), tip 2'de 124 (%46,6) ve tip 3'te 215 (%80,8) hasta vardı. En sık rastlantısal bulgular tip 1'de pnömoni, tip 2'de büyümüş mediastinal lenf nodları ve tip 3'te fibroatelektatik değişikliklerdi. Özellikle tip 1'deki hasta sayısı (hayatı tehdit eden veya acil tedavi gerektiren) PE ön tanısıyla incelenen hastalarda rastlantısal bulguların önemini ortaya koymaktadır.
Sonuç: Pulmoner emboli şüphesi olan hastalarda, bilgisayarlı tomografi pulmoner anjiyografi PE dışında önemli bir alternatif tanıya işaret edebilir.

Ethical Statement

Çıkar Çatışması Yazarlar bu çalışmayla ilgili herhangi bir çıkar çatışması beyan etmemektedir. Finansman Bu araştırma herhangi bir dış finansman almamıştır. Etik Onay Bu çalışma XXXX Etik Komitesi tarafından onaylanmıştır (Onay No: 2025-10/144). Bu çalışmada insan katılımcıları içeren tüm prosedürler, kurumsal ve/veya ulusal araştırma komitesinin etik standartlarına ve 1964 Helsinki Bildirgesi ve sonraki değişikliklerine uygun olarak yürütülmüştür. Bilgilendirilmiş Onam Çalışmaya dahil edilen tüm katılımcılardan bilgilendirilmiş onam alınmıştır.

Supporting Institution

yok

Thanks

Yazarlar, çalışma süresince teknik yardımları ve hasta bakımları için Radyoloji Bölümü çalışanlarına teşekkürlerini sunarlar.

References

  • Bukhari S, Hunter J, Bera K, et al. Clinical and imaging aspects of pulmonary embolism: a primer for radiologists. Clin Imaging. 2025;117: 110328. doi:10.1016/j.clinimag.2024.110328
  • Konstantinides SV, Torbicki A, Agnelli G, et al. ESC guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) endorsed by the European Respiratory Society (ERS). Eur Heart J. 2014;35(43):3033-3080. doi:10.1093/eurheartj/ehu283
  • Zantonelli G, Cozzi D, Bindi A, et al. Acute pulmonary embolism: prognostic role of computed tomography pulmonary angiography (CTPA). Tomography. 2022;8(1):529-539. doi:10.3390/tomography8010042
  • Abdurrahman Koc, Hulya Vatansev. Prognostic relevance of biochemical markers integrated with simplified pulmonary embolism severity index in acute pulmonary embolism. Ann Clin Anal Med. 2025; 16(12):893-898
  • Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019;3(3):315-330. doi:10.1002/rth2.12216
  • Dronkers C, Huisman M, Klok F. Clinical presentation of acute pulmonary embolism. Handbook of Venous Thromboembolism. 2017:21-26. doi.org/10.1002/9781119095606.ch3
  • Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-243. doi:10.21037/cdt.2017.12.01
  • Mamlouk MD, van Sonnenberg E, Gosalia R, et al. Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology. 2010;256:625-632. doi:10.1148/radiol.10091624
  • Zaw A, Nguyen R, Lam L, Kaplan A, Dobler CC. Effect of limiting the scan range of computed tomography pulmonary angiography (to reduce radiation exposure) on the detection of pulmonary embolism: a systematic review. Diagnostics. 2021;11(12):2179. doi:10.3390/diagnostics11122179
  • Tao SM, Wichmann JL, Schoepf UJ, Fuller SR, Lu GM, Zhang LJ. Contrast-induced nephropathy in CT: incidence, risk factors, and strategies for prevention. Eur Radiol. 2016;26(9):3310-3318. doi:10.1007/s00330-015-4155-8
  • Cereser L, Bagatto D, Girometti R, Como G, Zuiani C, Bazzocchi M. Chest multidetector computed tomography in patients with suspected acute pulmonary embolism: diagnostic yield and proportion of other clinically relevant findings. Radiol Med. 2011;116:219-229. doi:10.1007/s11547-010-0612-2
  • Aggarwal T, Eskandari A, Priya S, et al. Pulmonary embolism rule-out: positivity and factors affecting the yield of CT angiography. Postgrad Med J. 2020;96.
  • Costantino MM, Randall G, Gosselin M, Brandt M, Spinning K, Vegas CD. CT angiography in the evaluation of acute pulmonary embolus. AJR Am J Roentgenol. 2008;191(2):471-474. doi:10.2214/AJR.07.2552
  • Costa AF, Basseri H, Sheikh A, Stiell I, Dennie C. The yield of CT pulmonary angiograms to exclude acute pulmonary embolism. Emerg Radiol. 2014;21(2):133-141. doi:10.1007/s10140-013-1169-x
  • Perelas A, Dimou A, Saenz A, et al. Incidental findings on computed tomography angiography in patients evaluated for pulmonary embolism. Ann Am Thorac Soc. 2015;12(5):689-695. doi:10.1513/AnnalsATS.201404-144OC
  • Korkut M, Bedel C, Erman K, Yüksel S. Incidental findings of computed tomography angiography in patients suspected to have pulmonary embolism: a brief report. Arch Acad Emerg Med. 2019;7(1):e60.
  • Champion N, Hogan S, Flemming J. Assessing the prevalence of incidental findings identified by CTPA in women of reproductive age. Emerg Med Int. 2018;2018:1-5.
  • Jung JI, Kim KJ, Ahn MI, et al. Detection of pulmonary embolism using 64-slice multidetector-row computed tomography: accuracy and reproducibility on different image reconstruction parameters. Acta Radiol. 2011;52(4):417-421. doi:10.1258/ar.2011.100217
There are 18 citations in total.

Details

Primary Language English
Subjects Radiology and Organ Imaging
Journal Section Research Article
Authors

Erkan Bilgin 0000-0002-2054-1571

Elif Aktaş 0000-0002-2339-8707

Submission Date November 15, 2025
Acceptance Date January 16, 2026
Publication Date March 10, 2026
DOI https://doi.org/10.38053/acmj.1824519
IZ https://izlik.org/JA82RD84UF
Published in Issue Year 2026 Volume: 8 Issue: 2

Cite

AMA 1.Bilgin E, Aktaş E. Incidental findings in patients who underwent computed tomography angiography with a preliminary diagnosis of pulmonary embolism. Anatolian Curr Med J / ACMJ / acmj. 2026;8(2):174-178. doi:10.38053/acmj.1824519

TR DİZİN ULAKBİM and International Indexes (1b)

Interuniversity Board (UAK) Equivalency:  Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]

Note: Our journal is not WOS indexed and therefore is not classified as Q.

You can download Council of Higher Education (CoHG) [Yüksek Öğretim Kurumu (YÖK)] Criteria) decisions about predatory/questionable journals and the author's clarification text and journal charge policy from your browser. https://dergipark.org.tr/tr/journal/3449/file/4924/show

Journal Indexes and Platforms: 

TR Dizin ULAKBİM, Google Scholar, Crossref, Worldcat (OCLC), DRJI, EuroPub, OpenAIRE, Turkiye Citation Index, Turk Medline, ROAD, ICI World of Journal's, Index Copernicus, ASOS Index, General Impact Factor, Scilit.


The indexes of the journal's are;

18596


asos-index.png

f9ab67f.png

WorldCat_Logo_H_Color.png

      logo-large-explore.png

images?q=tbn:ANd9GcQgDnBwx0yUPRKuetgIurtELxYERFv20CPAUcPe4jYrrJiwXzac8rGXlzd57gl8iikb1Tk&usqp=CAU

index_copernicus.jpg


84039476_619085835534619_7808805634291269632_n.jpg





The platforms of the journal's are;

COPE.jpg

images?q=tbn:ANd9GcTbq2FM8NTdXECzlOUCeKQ1dvrISFL-LhxhC7zy1ZQeJk-GGKSx2XkWQvrsHxcfhtfHWxM&usqp=CAUicmje_1_orig.png


ncbi.png

ORCID_logo.pngimages?q=tbn:ANd9GcQlwX77nfpy3Bu9mpMBZa0miWT2sRt2zjAPJKg2V69ODTrjZM1nT1BbhWzTVPsTNKJMZzQ&usqp=CAU


images?q=tbn:ANd9GcTaWSousoprPWGwE-qxwxGH2y0ByZ_zdLMN-Oq93MsZpBVFOTfxi9uXV7tdr39qvyE-U0I&usqp=CAU






The
 
indexes/platforms of the journal are;

TR Dizin Ulakbim, Crossref (DOI), Google Scholar, EuroPub, Directory of Research Journal İndexing (DRJI), Worldcat (OCLC), OpenAIRE, ASOS Index, ROAD, Turkiye Citation Index, ICI World of Journal's, Index Copernicus, Turk Medline, General Impact Factor, Scilit 


Journal articles are evaluated as "Double-Blind Peer Review"

All articles published in this journal are licensed under a Creative Commons Attribution 4.0 International License (CC BY NC ND)