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Invited Commentary
Less Is More
September 2018

Are We Overtreating Isolated Subsegmental Pulmonary Embolism?First Do No Harm

Author Affiliations
  • 1F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
JAMA Intern Med. 2018;178(9):1274-1275. doi:10.1001/jamainternmed.2018.2970

The topic of isolated subsegmental pulmonary embolism (SSPE) is one of intense interest and controversy. In the modern era of computed tomography pulmonary angiography (CTPA), we have witnessed an increased prevalence of acute pulmonary embolism (PE). From 1998 to 2006, the detection of PE increased by 80% without, however, any change in PE mortality.1 Current technology allows highly accurate visualization of subsegmental vessels. Scanners can now image the entire thorax with a single breath hold, and detailed imaging of vessels down to the fifth order is possible. It is not surprising, then, that the rate of SSPE on studies has increased from reports averaging 4% with single-detector scanners to current rates as high as 15% with 64-row detectors.2

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