The Prevalence of Pulmonary Embolism in Patients With Interstitial Lung Disease: A Cross-Sectional Retrospective Study.

Rahmah Alsilmi

doi:10.7759/cureus.23063

Abstract

Objective: Interstitial lung disease (ILD) can be complicated by comorbidities, particularly pulmonary embolism (PE). We aimed to assess the prevalence of PE in ILD patients.Methods: Our study is a cross-sectional retrospective study conducted on ILD cases diagnosed between January 1, 2010, and June 30, 2021. Out of the total ILD cases (n = 153), we enrolled for analysis only those who underwent a computed tomography pulmonary angiography (CTPA) (n = 48). We recorded the number of patients who had a PE event on CTPA, gender, age at PE and ILD diagnoses, a chronology of PE with ILD diagnosis, PE characteristics, PE therapy, type of ILD, radiographic progression of ILD, presence of pulmonary hypertension, and mortality.Results: Seven patients out of 48, had PE (14.6%). The mean age at the time of PE diagnosis was 70 ± 9.73 years. No statistical difference existed between the PE and non-PE groups regarding gender predominance or the age at ILD diagnosis. All of the identified PE events (n = 7) were segmental (100%), one was saddle PE (14.3%) and one was recurrent (14.3%). No PE events were diagnosed prior to ILD diagnosis, three patients (42.9%) had a simultaneous diagnosis of PE and ILD, and four patients (57.1%) were diagnosed with a PE after ILD diagnosis by a mean time of eight months. No difference in ILD radiographic progression, pulmonary hypertension, or mortality between the two groups was found.Conclusion: PE is not uncommon in ILD and needs to be ruled out, especially in patients with worsening respiratory status.

Highlights

Interstitial lung diseases comprise varied disease patterns, including idiopathic interstitial pneumonia, ILDs with underlying etiologies, exposure-related ILDs, and granulomatous ILDs [1]
When ILD patients present with a change in their respiratory status, it is necessary to use computed tomography pulmonary angiography (CTPA) to rule out Pulmonary embolism (PE) before labeling the condition as an acute exacerbation of ILD (AEILD), which has a worse prognosis than PE
The mean age at the time of ILD diagnosis based on the first chest computed tomography (CT) documenting ILD was 70 ± 9.78 years in the PE group and 61.4 ± 14.42 years in the non-PE group

Summary

Introduction

Interstitial lung diseases comprise varied disease patterns, including idiopathic interstitial pneumonia (such as idiopathic pulmonary fibrosis, IPF), ILDs with underlying etiologies (such as connective tissue diseaseassociated ILD, CTD-ILD), exposure-related ILDs (such as hypersensitivity pneumonitis, HP), and granulomatous ILDs (such as sarcoidosis) [1]. Comorbid medical conditions should be carefully screened for and diagnosed, such as pulmonary embolism, pulmonary hypertension (PH), emphysema, lung cancer, coronary artery disease, gastroesophageal reflux disease, and sleep-disordered breathing. These comorbidities, which have been reported in patients with ILD at different prevalence rates, can contribute to morbidity and mortality [2,3]. PE should be included in the differential diagnosis when a patient with ILD presents with acute or gradual worsening of respiratory status, newly developed PH, or hypoxemia that is out of keeping with the degree of parenchymal lung disease for which it is important to investigate for PE, as it is considered a potentially treatable condition. We described the PE events using clinical and radiographic features

Methods

Results

Discussion

Conclusion