TY - JOUR
T1 - Primary pulmonary thrombus in combat casualties
T2 - Is treatment necessary?
AU - Bradley, Matthew J.
AU - Baird, Dean E.
AU - Peterson, Paul G.
AU - Baird, Michael D.
AU - Elster, Eric A.
AU - Rodriguez, Carlos J.
N1 - Publisher Copyright:
© 2018 Southeastern Surgical Congress. All rights reserved.
PY - 2018/6
Y1 - 2018/6
N2 - The objective of this study was to describe the natural history of primary pulmonary thrombus (PPT) in combat casualties. This was a retrospective study of casualties treated at a major military treatment facility from 2010 to 2012. Patients with a downrange chest CT were included. CTs were reviewed by two independent, blinded radiologists to confirm PPT on initial imaging. Follow-up CTs, if obtained, were also independently reviewed to determine the extent of clot burden. Two hundred and forty-nine casualties with a downrange, acceptable quality chest CT were included. 9 per cent (23/249) of patients sustained PPT. Thirty nine per cent (9/23) were initially treated with therapeutic anticoagulation (AC). Conversely, 61 per cent (14/23) arrived to our military treatment facility without AC. Seven arriving without AC-developed pulmonary symptoms during their hospitalization and had interval chest CTs. Of those, three had no evidence of pulmonary thrombus. The other four had subsegmental filling defects and three were started AC whereas one had an IVC (Inferior Vena Cava) filter inserted. In total, 11/23 (48%) PPT patients were managed without AC and discharged without complications. This is the first study attempting to look at PPT natural history. There were no adverse sequelae from managing PPT without AC. Further studies are warranted to further characterize PPT.
AB - The objective of this study was to describe the natural history of primary pulmonary thrombus (PPT) in combat casualties. This was a retrospective study of casualties treated at a major military treatment facility from 2010 to 2012. Patients with a downrange chest CT were included. CTs were reviewed by two independent, blinded radiologists to confirm PPT on initial imaging. Follow-up CTs, if obtained, were also independently reviewed to determine the extent of clot burden. Two hundred and forty-nine casualties with a downrange, acceptable quality chest CT were included. 9 per cent (23/249) of patients sustained PPT. Thirty nine per cent (9/23) were initially treated with therapeutic anticoagulation (AC). Conversely, 61 per cent (14/23) arrived to our military treatment facility without AC. Seven arriving without AC-developed pulmonary symptoms during their hospitalization and had interval chest CTs. Of those, three had no evidence of pulmonary thrombus. The other four had subsegmental filling defects and three were started AC whereas one had an IVC (Inferior Vena Cava) filter inserted. In total, 11/23 (48%) PPT patients were managed without AC and discharged without complications. This is the first study attempting to look at PPT natural history. There were no adverse sequelae from managing PPT without AC. Further studies are warranted to further characterize PPT.
UR - http://www.scopus.com/inward/record.url?scp=85049715029&partnerID=8YFLogxK
U2 - 10.1177/000313481808400640
DO - 10.1177/000313481808400640
M3 - Article
C2 - 29981623
AN - SCOPUS:85049715029
SN - 0003-1348
VL - 84
SP - 909
EP - 915
JO - American Surgeon
JF - American Surgeon
IS - 6
ER -