Incidental and Symptomatic Pulmonary Thromboembolism: Clinical Features and Prognostic Comparison

Incidental and Symptomatic Pulmonary Thromboembolism: Clinical Features and Prognostic Comparison | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidental and Symptomatic Pulmonary Thromboembolism: Clinical Features and Prognostic Comparison Ferhan Karataş, Coşkun Doğan, Öner Dikensoy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8695116/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Incidental pulmonary thromboembolism (iPTE) is increasingly being detected owing to the widespread use of computed tomography; however, its clinical significance and prognostic impact compared with symptomatic pulmonary thromboembolism (sPTE) remains controversial. Materials and Methods This retrospective observational study included adult patients with acute pulmonary embolism confirmed using CT pulmonary angiography between January 2022 and January 2025. Patients were classified as having iPTE or sPTE based on the clinical presentation and indications for imaging. Demographic characteristics, comorbidities, clinical findings, laboratory parameters, imaging features, and outcomes were compared between groups. Survival was assessed using Kaplan–Meier analysis, and predictors of mortality were evaluated using Cox regression analysis. Results A total of 306 patients were included, of whom 42 (13.7%) had iPTE and 264 (86.3%) had sPTE. Patients with iPTE had a higher prevalence of malignancy and comorbidities, but showed lower heart rate, higher oxygen saturation, lower cardiac biomarker levels, and less right ventricular dysfunction. Radiologically, iPTE was associated with a less extensive embolic burden and fewer parenchymal complications. The median survival did not differ significantly between the iPTE and sPTE groups (log-rank, p = 0.346). In multivariate analysis, malignancy (hazard ratio [HR] 3.07, p < 0.001) and elevated troponin T (HR 2.70, p = 0.002) were independent predictors of mortality, whereas iPTE status was not. Conclusion Despite a lower hemodynamic and radiological burden, incidental pulmonary thromboembolism was associated with survival comparable to that of symptomatic cases. Mortality was primarily driven by underlying malignancy and myocardial injury rather than by embolism presentation. Trial registration Not applicable (retrospective observational study). Pulmonology Pulmonary embolism Incidental pulmonary embolism Prognosis Risk stratification Figures Figure 1 Figure 2 Introduction Pulmonary thromboembolism (PTE) is a serious clinical condition within the spectrum of venous thromboembolic diseases, which can cause high morbidity and mortality. [ 1 – 4 ] Approximately 20% of patients with cancer develop PTE at least once during treatment and follow-up. [ 3 ] The recurrence of PTE in patients with cancer is three times higher, and it is the most common cause of death after cancer progression. Incidental pulmonary thromboembolism (iPTE) is defined as the unexpected detection of filling defects in pulmonary arteries on imaging performed without clinical suspicion of PTE. [ 4 , 5 ] In addition to classical symptomatic cases, the diagnosis of iPTE has increased with the widespread use of imaging techniques. [ 6 , 7 ] In iPTE, the diagnosis of symptomatic PTE (sPTE) may be missed because the symptoms are often attributed to treatment or underlying disease. [ 8 , 9 ] For this reason, the term “incidental” is preferred instead of “asymptomatic.” In oncological patients, iPTE is detected more frequently owing to the frequent use of contrast-enhanced chest computed tomography (CT), and its prevalence has been reported to range between 1% and 15%. [ 2 , 3 , 5 , 10 , 11 ] Moreover, beyond being merely a radiological diagnosis, iPTE may represent an indicator of poor cancer prognosis, and further investigation of malignancy is recommended in patients with iPTE. [ 12 – 15 ] Although studies have evaluated the prognosis of iPTE, there is no standardized management algorithm. [ 9 ] It has also been suggested that the risk factors and clinical characteristics of iPTE may differ from those of sPTE. In incidental PTE, the absence of prominent symptoms often leads to a diagnosis being made during staging or follow-up CT performed for another disease. [ 6 , 8 ] However, it remains unclear whether these patients have a better clinical course than those with sPTE. [ 3 , 7 ] Although some studies have reported that survival in patients with iPTE is similar to that in symptomatic cases [ 1 , 7 , 16 ] , others have suggested that the risk of mortality may be lower. [ 3 , 5 ] The factors that may cause clinical and prognostic differences between the two groups are still under debate. [ 5 ] There is no consensus regarding the treatment approach. Some guidelines recommend managing iPTE similar to sPTE; however, the necessity of this approach in non-oncological patient populations remains controversial. [ 1 – 3 , 5 – 7 , 10 ] This study aimed to compare patients diagnosed with iPTE and sPTE who presented to our clinic in terms of clinical, radiological, and laboratory findings as well as mortality and disease course. Materials and Methods Study Design and Patient Population The study was approved by the local institutional ethics committee and conducted in accordance with the Declaration of Helsinki. The requirement for informed consent was waived due to the retrospective design. Patients aged ≥ 18 years who were diagnosed with acute PTE confirmed by chest computed tomography pulmonary angiography (CTPA) between January 2022 and January 2025 and whose clinical, laboratory, and radiological data were available were included in the study. Patients with a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), detected chronic thrombus, inadequate chest CT image quality, or diagnosed by ventilation–perfusion scintigraphy were excluded from the study. Collection of Data and Variables Patient data were retrieved from the hospital automation systems. PTE diagnosis in all patients was confirmed based on CTPA findings. All CTPA images, radiology reports, and indications for imaging requests were reviewed. Radiologically, thrombus laterality (unilateral or bilateral) and pulmonary artery localization (main pulmonary artery trunk, right and left main pulmonary arteries, and lobar, segmental, and subsegmental) were recorded. Demographic characteristics, dates of PTE diagnosis, presence of symptoms, comorbidities, hemodynamic stability status, laboratory parameters, oxygen saturation levels, length of hospital stay, anticoagulation regimens, need for intensive care, and dates of death of patients who were not alive at the time of data collection were recorded. Right ventricular assessment, classification of PTE-related clinical risk factors, and determination of acute mortality risk groups were performed based on the definitions and algorithms of the 2019 ESC/ERS acute pulmonary embolism guideline published in line with the joint recommendations of the European Society of Cardiology and the European Respiratory Society. [ 1 ] Definition and Classification Patients diagnosed with PTE were divided into two groups based on the clinical findings at presentation and indications for imaging. Patients who presented with acute symptoms, such as dyspnea, chest pain, tachycardia, hemoptysis, syncope, or hypoxemia, and in whom thrombus was detected on CTPA were classified as sPTE. Patients without suspicion of PTE, in whom filling defects in the pulmonary arteries were incidentally detected on imaging performed for oncological staging, infection evaluation, or other clinical reasons, and who did not report PTE-specific symptoms, were included in the iPTE group. Statistical Analysis Statistical analyses were performed using IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD) and categorical variables as percentages (%). Student’s t-test or Mann–Whitney U test was used for comparisons between groups, while the chi-square test or Fisher’s exact test was used for categorical data. Cox regression analysis and Kaplan–Meier survival curves were generated to identify the factors affecting mortality. Statistical significance was set at p < 0.05. Results A total of 306 patients with a mean age of 64.9 ± 16.94 years, including 172 women (56.2%), were included in the study; of these, 264 (86.3%) were in the sPTE group and 42 (13.7%) were in the iPTE group. In terms of comorbidity distribution, the presence of at least one comorbid disease (p = 0.023) and cancer (p < 0.001) were more frequent in the iPTE group, whereas chronic respiratory disease was more common in the sPTE group (p = 0.049). A history of immobilization or surgery within the previous four weeks was more frequent in the iPTE group (p = 0.038). The detailed demographic, clinical, comorbidity, and treatment characteristics of the patients are presented in Table 1 . Table 1 Demographic Characteristics, Comorbidities, Clinical Findings, and Treatment Approaches All Patients (n = 306) sPTE (n = 264) iPTE (n = 42) p Gender n (%) Male 134 (43.8%) 111 (42.0%) 23 (54.8%) 0.123 Female 172 (56.2%) 153 (58.0%) 19 (45.2%) Age (Years) (Mean ± SD) 64 ± 16.94 64.56 ± 17.32 65.43 ± 14.55 0.758 Vital Findings Fever (Mean ± SD) 36 ± 0.49 36.61 ± 0.46 36.74 ± 0.62 0.270 Heart rate (Mean ± SD) 91 ± 19.72 92.62 ± 19.98 84.40 ± 16.44 0.014 Heart rate > 110 bpm n (%) 71 (23.2%) 65 (24.6%) 6 (14.3%) 0.141 SBP (mmHg) (Mean ± SD) 123 ± 23.02 123.93 ± 23.78 123.22 ± 17.72 0.855 DBP (mmHg) (Mean ± SD) 73 ± 12.02 73.63 ± 12.38 76.05 ± 9.37 0.227 Systolic BP 30/min (%) 22 (7.20%) 21 (8.00%) 1 (2.40%) 0.332 Pulse sPO2 (Mean ± SD) 92 ± 5.51 91.73 ± 5.69 94.71 ± 3.26 < 0.001 Pulse sPO2 < 90 n (%) 83 (27.1%) 79 (29.9%) 4 (9.50%) 0.006 Comorbidity n (%) Any comorbidities 263 (85.9%) 222 (84.1%) 41 (97.6%) 0.023 Cancer 107 (35.0%) 78 (29.5%) 29 (69.0%) < 0.001 Cardiac Disease 53 (17.3%) 49 (18.6%) 4 (9.50%) 0.151 Chronic Lung Disease 55 (18.0%) 52 (19.7%) 3 (7.10%) 0.049 KBY 9 (2.90%) 8 (3.00%) 1 (2.40%) 1,000 Neurological Disease 42 (13.7%) 37 (14.0%) 5 (11.9%) 0.712 HT 126 (41.2%) 114 (43.2%) 12 (28.6%) 0.074 DM 73 (23.9%) 65 (24.6%) 8 (19.0%) 0.431 Other 34 (11.1%) 32 (12.1%) 2 (4.80%) 1,000 Clinical Characteristics n (%) DVT Symptoms and Signs 73 (23.9%) 62 (23.5%) 11 (26.2%) 0.702 Tachycardia 93 (30.4%) 87 (33.0%) 6 (14.3%) 0.015 Immobilization – Surgery 147 (48.0%) 125 (47.3%) 22 (52.4%) 0.038 History of DVT or PTE 46 (15.0%) 39 (14.8%) 7 (16.7%) 0.757 Hemoptysis 13 (4.20%) 13 (4.90%) 0 (0.00%) 0.228 Mental Change 10 (3.30%) 10 (3.80%) 0 (0.00%) 0.368 Hemodynamic instability 27 (8.80%) 24 (9.10%) 3 (7.10%) 1,000 Clinical outcomes n (%) Outpatient 14 (4.60%) 5 (1.90%) 9 (21.4%) < 0.001 Inpatient 259 (84.6%) 227 (86.0%) 32 (76.2%) ICU 7 (2.30%) 7 (2.70%) 0 (0.00%) Exitus 26 (8.50%) 25 (9.50%) 1 (2.40%) Length of hospital stay (Day) (Mean ± SD) 7.4 ± 5.96 7.81 ± 5.88 4.98 ± 5.97 0.004 Anticoagulant Therapy n (%) Warfarin 43 (14.1%) 41 (15.5%) 2 (4.80%) 0.169 DMAH 143 (46.7%) 121 (45.8%) 22 (52.4%) DOAC 117 (38.2%) 99 (37.5%) 18 (42.9%) Thrombolytic Therapy n (%) 9 (2.90%) 9 (3.40%) 0 (0.00%) 0.616 Overall survival (Months) (Mean ± SD) 22 ± 17.54 22.82 ± 17.90 21.37 ± 15.17 0.624 When PTE-related risk factors and clinical risk classifications were evaluated, the proportion of patients without risk factors was higher in the sPTE group than in the iPTE group, whereas the proportion of patients with intermediate-risk factors was lower (p = 0.004). In the 30-day mortality risk assessment, the proportion of patients with intermediate–low risk was higher in the iPTE group, while the proportion of patients with intermediate–high and high risk was lower (p = 0.019). The detailed results are presented in Supplementary Table S1 . Echocardiographic findings showed that the presence of pulmonary hypertension (PH) (p = 0.001), mean pulmonary artery systolic pressure (PASP) (p < 0.001), and right ventricular dysfunction were lower in the iPTE group (p < 0.001). Radiological evaluation revealed that involvement of the main pulmonary artery was higher in the iPTE group (p = 0.025). The presence of bilateral pulmonary artery involvement at any level was lower in the iPTE group (p = 0.016). In the iPTE group, the presence of parenchymal infarction (p = 0.028), mean number of infarcted segments (p = 0.001), and rate of embolism-related pleural effusion were lower (p = 0.026). The detailed echocardiographic and imaging findings are presented in Table 2 . Table 2 Echocardiographic and Radiological Imaging Findings All Patients (n = 306) sPTE (n = 264) iPTE (n = 42) p ECO Findings Pulmonary HT n (%) 195 (63.7%) 174 (65.9%) 21 (50.0%) 0.001 PASP (mmHg) (Mean ± SD) 37,±15.04 39.28 ± 15.49 29.50 ± 8.26 < 0.001 Right Ventricular Finding n (%) 101 (33.0%) 97 (36.7%) 4 (9.50%) < 0.001 Thrombus Localization n (%) Main Pulmonary Artery 9 (2.90%) 5 (1.90%) 4 (9.50%) 0.025 Right Main Pulmonary Artery 84 (27.5%) 73 (27.7%) 11 (26.2%) 0.789 Left Main Pulmonary Artery 47 (15.4%) 39 (14.8%) 8 (19.0%) 0.509 Bilateral Main Pulmonary Arteries 72 (23.5%) 63 (23.9%) 9 (21.4%) 0.683 Main Pulmonary Artery (Right or left) 139 (45.4%) 123 (46.6%) 16 (38.1%) 0.257 Unilateral Segmentary PA Branches 97 (31.7%) 76 (28.8%) 21 (50.0%) 0.008 Bilateral Segmentary PA Branches 181 (59.2%) 163 (61.7%) 18 (42.9%) 0.014 Segmental PA Branches (Right or Left) 277 (90.5%) 238 (90.2%) 39 (92.9%) 1,000 Unilateral Subsegmental PA Branches 69 (22.5%) 57 (21.6%) 12 (28.6%) 0.348 Bilateral Subsegmental PA Branches 165 (53.9%) 151 (57.2%) 14 (33.3%) 0.003 Subsegmental PA Branches (Right or Left) 234 (76.5%) 208 (78.8%) 26 (61.9%) 0.008 Bilateral PA Branches (Any level) 238 (77.7%) 236 (89.3%) 32 (76.1%) 0.016 Patients with Parenchymal Infarction n (%) 120 (39.2%) 110 (41.7%) 10 (23.8%) 0.028 Number of Infarcted Segments (Mean ± SD) 0.7 ± 1.05 0.76 ± 1.09 0.34 ± 0.66 0.001 Pleural Fluid Due to Embolism n (%) 69 (22.5%) 65 (24.6%) 4 (9.50%) 0.026 Lower extremity DVT n (%) 108 (35.3%) 87 (33.0%) 21 (50.0%) 0.229 When hematological and biochemical parameters were evaluated, the iPTE group had lower mean leukocyte counts (p = 0.003), hemoglobin levels (p = 0.021), and mean C-reactive protein (CRP) levels (p = 0.002), while the mean procalcitonin (PCT) level was higher (p = 0.002). The detailed results of the hematological, biochemical, and cardiac parameters are presented in Supplementary Table S2 . In the Kaplan–Meier survival analyses, there was no significant difference in survival between iPTE and sPTE (p = 0.346) (Fig. 1 ) or between bilateral and unilateral PTE (p = 0.067) ( Supplementary Fig. S1 ). In contrast, survival was lower in patients with acute lower extremity DVT (deep vein thrombosis) (p = 0.011), elevated TnT levels (p < 0.001), admission sPO₂ < 90% (p = 0.020), and tachycardia (p = 0.009) ( Supplementary Figs. S2–S5 ). The overall model was statistically significant in the Cox regression analysis (omnibus test: χ² = 26.674; df = 5; p < 0.001). A history of cancer (HR = 3.067; p < 0.001) and elevated TnT levels (HR = 2.704; p = 0.002) significantly increased the risk of mortality. In contrast, bilateral involvement (HR = 0.502; p = 0.070), PASP (HR = 0.996; p = 0.695), and iPTE (HR = 1.201; p = 0.630) did not significantly affect mortality ( Supplementary Fig. S6 ). Discussion The results of this study indicate that patients with iPTE have a higher comorbidity burden than those with sPTE, thrombi are located in more proximal branches, parenchymal infarction develops less frequently, and echocardiographic findings are milder. However, no significant difference in survival duration was observed between the two groups. Previous studies have reported that patients with iPTE exhibit a milder phenotype, with lower PESI scores, less central embolism, and less right ventricular dilatation on CT. [ 12 , 16 , 17 ] In the present study, the Wells scores and short-term mortality risk classifications were also lower in the iPTE group. However, in pulmonary embolism, in addition to clinical scoring systems, TnT, BNP, and right ventricular dysfunction are key prognostic tools for predicting short-term mortality. [ 18 ] Scores such as the Hull-CPR, which are based on ECOG performance status and symptom profile, aim to identify a vulnerable phenotype beyond the classical PESI/Wells approach, particularly in cancer patients. [ 19 ] Despite the lower clinical risk scores in iPTE cases, the high burden of malignancy and comorbidities suggests that individualized approaches incorporating performance status and treatment intensity should be integrated into the clinical decision-making process. The lower frequency of pulmonary hypertension, lower PASP values, and fewer RV strain findings in the iPTE group than in the sPTE group support the idea that incidental cases have a hemodynamically milder phenotype. Studies have also reported that central embolism, RV dilatation, and short-term adverse events are less frequent in iPTE. [ 16 , 17 ] In cancer-associated iPTE, centrally located emboli have been shown to be associated with a poorer prognosis. [ 7 ] The lower PASP and RV strain findings in the iPTE cases may be explained by the predominance of a more peripheral or limited embolic burden. As recommended by current guidelines, the assessment of clinical scores, together with TnT/BNP levels and RV dysfunction, provides comprehensive risk stratification for short-term mortality. [ 18 ] Peris et al. demonstrated that VTE recurrence and major bleeding rates may be similar between iPTE and sPTE, emphasizing that these patients should not be underestimated despite low-risk scores. [ 12 ] The impact of embolus localization on prognosis has been reported in different studies; prognosis in proximal iPTE has been shown to be like that in sPTE, whereas in SSPE, embolus size and number have not been shown to have a significant effect on mortality. [ 5 – 7 , 10 , 20 ] With the widespread use of multidetector CTPA, the increased diagnosis of PTE has led to more frequent detection of clinically insignificant SSPE and to discussions of “overdiagnosis” in iPTE. [ 21 ] Therefore, the treatment approach for iPTE remains controversial, and individualized treatment is recommended in SSPE cases by considering the presence of DVT, symptom status, and bleeding risk. [ 5 – 7 , 22 ] Armitage et al. reported that a “surveillance and DVT screening” strategy may be appropriate for SSPE. [ 22 ] Conflict ing results exist in the literature regarding radiological phenotypes. Some studies have reported that iPTE is located more distally and unilaterally, whereas others have shown an association with more proximal emboli and lower mortality. [ 20 , 23 ] Although central emboli in cancer-associated iPTE have been reported to be associated with poorer survival, some studies have demonstrated better overall survival despite a high rate of central involvement. [ 7 , 20 ] These findings suggest that prognosis depends not only on thrombus localization but also on the total clot burden and bilaterality. In our study, the presence of more widespread bilateral thrombus, pulmonary infarction, and pleural effusion in the sPTE group indicated a more severe clinical phenotype, whereas the more limited clot burden and less parenchymal damage in the iPTE group suggested that incidental detection may reflect an earlier disease stage. Lower CRP and leukocyte levels and higher PCT levels in the iPTE group suggested that the inflammatory response may differ between the two types of PTE. In our previous study, elevated CRP levels and fever were more frequent in patients with PTE with pulmonary infarction. [ 24 ] Accordingly, the higher CRP and leukocyte levels observed in the sPTE group supported an acute inflammatory phenotype. The elevated PCT level observed in iPTE may reflect a vulnerable patient profile associated with malignancy-related systemic inflammation and metabolic stress rather than infection. [ 3 , 7 , 23 , 25 ] Lower TnT and BNP levels in the iPTE group indicated a milder clinical picture in terms of right ventricular pressure load and myocardial stress. This finding is consistent with the literature demonstrating the prognostic value of cardiac biomarkers in PTE. [ 18 , 26 ] Moreover, radiologically proximal, or central emboli have been reported to be associated with more pronounced RV strain and poorer survival. [ 7 , 23 ] The identification of elevated TnT levels as an independent predictor of mortality in our Cox regression analysis further supports this association. In the literature, iPTE has been reported to be associated with a better prognosis in some series [ 12 , 16 , 17 , 20 ] , whereas in others, it has been associated with similar or even worse outcomes, particularly in patients with cancer. [ 14 , 23 , 25 , 27 ] This heterogeneity suggests that survival is determined more by the clinical and biological burden of the patient than by the mode of embolus detection. In iPTE, mortality often results not from the embolism itself, but from cancer biology, performance status, and frailty. [ 15 , 19 , 25 , 27 ] Accordingly, the similar survival observed between iPTE and sPTE in our study and the identification of cancer history and elevated TnT levels as determinants of mortality indicate that prognosis is primarily driven by malignancy and hemodynamic stress. The higher rate of outpatient follow-up in the iPTE group and the longer hospitalization duration in the sPTE group highlight the differences in clinical management requirements between the two groups. The literature has reported that a proportion of iPTE cases can be managed on an outpatient basis under appropriate anticoagulation [ 2 , 12 , 19 – 21 ] , and this approach is also consistent with the ASH and ASCO guidelines. [ 28 , 29 ] Limitations This study has limitations inherent to its single-center, retrospective observational design, including potential selection and information bias. The imbalance in malignancy and comorbidity burden between groups may have introduced residual confounding despite multivariable adjustment. Finally, external validity may be limited and the findings should be confirmed in larger multicenter cohorts. Conclusion Incidental pulmonary thromboembolism is associated with a lower hemodynamic and radiological burden than symptomatic cases, while demonstrating comparable survival. Mortality appears to be driven primarily by underlying clinical and biological vulnerability, particularly malignancy and myocardial stress, rather than by whether embolism is detected incidentally or symptomatically. These findings suggest that patient-based risk profiles may be more informative than the mode of PTE presentation when interpreting prognosis. Declarations Author Contributions F.K.: Conceptualization, study design, data analysis, interpretation of results, manuscript drafting, and final approval. C.D.: Statistical analysis, and critical revision of the manuscript. Ö.D.: Supervision, study oversight, critical revision of the manuscript, and final approval. Ethics approval and consent to participate The study was approved by the Koç University Clinical Research Ethics Committee, Koç University, İstanbul, Türkiye (Decision No: 2025.616.IRB1.089). Due to the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee. Consent for publication Not applicable. Conflict of Interest Statement The authors declare that they have no conflict of interest. Funding Sources This study received no specific funding from any public, commercial, or not-for-profit sector. Data Availability Statement The datasets generated and/or analyzed during the current study are not publicly available due to ethical and legal restrictions related to patient confidentiality but are available from the corresponding author upon reasonable request. 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Respir Med 157:26–35 van der Hulle T, den Exter PL, Planquette B, Meyer G, Soler S, Monreal M et al (2016) Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: a pooled analysis of 926 patients. J Thromb Haemost 14:105–113 Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA et al (2021) American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 5:927–974 Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI et al (2020) Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 38:496–520 Additional Declarations The authors declare no competing interests. Supplementary Files SupplementaryMaterial.docx Supplementary Files SupplementaryFig.S2.jpg Supplementary Fig. S2. Kaplan–Meier survival curves according to the presence of acute lower extremity deep vein thrombosis (DVT). Patients with acute lower extremity DVT showed significantly lower survival compared with those without DVT (log-rank test, p = 0.011). SupplementaryFig.S3.jpg Supplementary Fig. S3. Kaplan–Meier survival curves according to troponin T (TnT) levels. Elevated TnT levels were associated with significantly reduced survival compared with normal TnT levels (log-rank test, p < 0.001). SupplementaryFig.S4.jpg Supplementary Fig. S4. Kaplan–Meier survival curves according to admission peripheral oxygen saturation (sPO₂). Patients with admission sPO₂ < 90% had significantly lower survival than those with sPO₂ ≥ 90% (log-rank test, p = 0.020). SupplementaryFig.S5.jpg Supplementary Fig. S5. Kaplan–Meier survival curves according to the presence of tachycardia at presentation. Survival was significantly lower in patients with tachycardia compared with those without tachycardia (log-rank test, p = 0.009). SupplementaryFig.S6.jpg Supplementary Fig. S6. Adjusted survival curve derived from the Cox proportional hazards regression model for the entire cohort. The curve represents estimated cumulative survival at the mean values of the covariates included in the model. History of cancer and elevated troponin T levels were independently associated with increased mortality. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8695116","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580185243,"identity":"cad0064c-3ed9-4713-a375-36dfe2c576da","order_by":0,"name":"Ferhan Karataş","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYBAC9h4og429+RiUQUALzxkQmcDAwMdzLA3MYGMmVoucRI4ZmMFAUAvP4Wcffv6ws2eTyPn24OOPbfJ8zAyMHz7m4NHC22Y8sychObGN5+12wxkJtw3bmBmYJWduw63Fnp/BmIEngTmBjT13mzRPwm1GoBY2Zl48Wnj42T8z/kmot2djyHkG0mJPWAtvjzEzT8JhxjaOHDaQlkTCWnjOFDPLpB0H+uWYmeSMtNvJbcyMzXj9wsOTvpnxjU21vXx78zOJDza3bee3Nx/88BGPFmyAsYE09aNgFIyCUTAKMAAAB95GnkGL+B4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-4025-3446","institution":"Koç University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ferhan","middleName":"","lastName":"Karataş","suffix":""},{"id":580187597,"identity":"65d75ab5-0a4e-4852-82b4-2b085429f0c7","order_by":1,"name":"Coşkun Doğan","email":"","orcid":"https://orcid.org/0000-0002-6948-5187","institution":"Medeniyet University Medicine Faculty","correspondingAuthor":false,"prefix":"","firstName":"Coşkun","middleName":"","lastName":"Doğan","suffix":""},{"id":580187598,"identity":"16734e04-8fc3-45c9-ab1d-6ef2db9108af","order_by":2,"name":"Öner Dikensoy","email":"","orcid":"https://orcid.org/0000-0003-1161-6225","institution":"Koç University Medicine Faculty","correspondingAuthor":false,"prefix":"","firstName":"Öner","middleName":"","lastName":"Dikensoy","suffix":""}],"badges":[],"createdAt":"2026-01-25 22:43:20","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8695116/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8695116/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101214418,"identity":"c740f5f2-6a14-4776-a2f5-24758fd9e059","added_by":"auto","created_at":"2026-01-27 10:34:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2120950,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier survival curves comparing patients with incidental pulmonary thromboembolism (iPTE) and symptomatic pulmonary thromboembolism (sPTE). Survival time is shown in months. Censored observations are indicated by tick marks. There was no significant difference in overall survival between the two groups (log-rank test, p = 0.346).\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/a03ddcc2625c7db8b03fdf2f.jpg"},{"id":101214312,"identity":"87da6ab3-4daa-4f98-aba2-bb402bad7d1e","added_by":"auto","created_at":"2026-01-27 10:34:40","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2120950,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier survival curves comparing patients with incidental pulmonary thromboembolism (iPTE) and symptomatic pulmonary thromboembolism (sPTE). Survival time is shown in months. Censored observations are indicated by tick marks. There was no significant difference in overall survival between the two groups (log-rank test, p = 0.346).\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/7dd63246059b8316effdbdf0.jpg"},{"id":101214432,"identity":"847a55cc-8dc9-4120-95cd-38afa6f9421f","added_by":"auto","created_at":"2026-01-27 10:35:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5162921,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/0544fb62-799d-454c-884a-5d43682ff7b2.pdf"},{"id":101214282,"identity":"e743839d-3c53-4740-a365-62bd0a66db7a","added_by":"auto","created_at":"2026-01-27 10:34:25","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33275,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary Files\u003c/p\u003e","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/b9e98fd26b7ffa786fb4d150.docx"},{"id":101214394,"identity":"570c8259-e23f-4412-8981-fe09e3cce813","added_by":"auto","created_at":"2026-01-27 10:34:57","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":2125176,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Fig. S2.\u003c/strong\u003e Kaplan–Meier survival curves according to the presence of acute lower extremity deep vein thrombosis (DVT). Patients with acute lower extremity DVT showed significantly lower survival compared with those without DVT (log-rank test, p = 0.011).\u003c/p\u003e","description":"","filename":"SupplementaryFig.S2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/8b3d2f0a38905b64570b4c9d.jpg"},{"id":101214278,"identity":"714d3506-b942-4a8c-ab97-4204f59afb8e","added_by":"auto","created_at":"2026-01-27 10:34:24","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":2148178,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Fig. S3.\u003c/strong\u003e Kaplan–Meier survival curves according to troponin T (TnT) levels. Elevated TnT levels were associated with significantly reduced survival compared with normal TnT levels (log-rank test, p \u0026lt; 0.001).\u003c/p\u003e","description":"","filename":"SupplementaryFig.S3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/e60cf31b0e5dac732496a2f1.jpg"},{"id":101214281,"identity":"70fff88a-bc59-4daa-a6cb-effda11a5a39","added_by":"auto","created_at":"2026-01-27 10:34:25","extension":"jpg","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":2100998,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Fig. S4.\u003c/strong\u003e Kaplan–Meier survival curves according to admission peripheral oxygen saturation (sPO₂). Patients with admission sPO₂ \u0026lt; 90% had significantly lower survival than those with sPO₂ ≥ 90% (log-rank test, p = 0.020).\u003c/p\u003e","description":"","filename":"SupplementaryFig.S4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/81c5154d5027e83c30581cf3.jpg"},{"id":101214420,"identity":"4da7bc03-42c5-427f-ab7b-aa7bf339cdd1","added_by":"auto","created_at":"2026-01-27 10:34:58","extension":"jpg","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":2077457,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Fig. S5.\u003c/strong\u003e Kaplan–Meier survival curves according to the presence of tachycardia at presentation. Survival was significantly lower in patients with tachycardia compared with those without tachycardia (log-rank test, p = 0.009).\u003c/p\u003e","description":"","filename":"SupplementaryFig.S5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/0792b4a0d2a5a951b048d00c.jpg"},{"id":101214388,"identity":"67dd4db6-cddf-4ab9-b81d-a93028319c0f","added_by":"auto","created_at":"2026-01-27 10:34:54","extension":"jpg","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":1979951,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Fig. S6.\u003c/strong\u003e Adjusted survival curve derived from the Cox proportional hazards regression model for the entire cohort. The curve represents estimated cumulative survival at the mean values of the covariates included in the model. History of cancer and elevated troponin T levels were independently associated with increased mortality.\u003c/p\u003e","description":"","filename":"SupplementaryFig.S6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8695116/v1/86f69ee0a9d8a686b72844b7.jpg"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eIncidental and Symptomatic Pulmonary Thromboembolism: Clinical Features and Prognostic Comparison\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePulmonary thromboembolism (PTE) is a serious clinical condition within the spectrum of venous thromboembolic diseases, which can cause high morbidity and mortality.\u003csup\u003e[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e Approximately 20% of patients with cancer develop PTE at least once during treatment and follow-up.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e The recurrence of PTE in patients with cancer is three times higher, and it is the most common cause of death after cancer progression.\u003c/p\u003e \u003cp\u003eIncidental pulmonary thromboembolism (iPTE) is defined as the unexpected detection of filling defects in pulmonary arteries on imaging performed without clinical suspicion of PTE.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e In addition to classical symptomatic cases, the diagnosis of iPTE has increased with the widespread use of imaging techniques.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e In iPTE, the diagnosis of symptomatic PTE (sPTE) may be missed because the symptoms are often attributed to treatment or underlying disease.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e For this reason, the term \u0026ldquo;incidental\u0026rdquo; is preferred instead of \u0026ldquo;asymptomatic.\u0026rdquo; In oncological patients, iPTE is detected more frequently owing to the frequent use of contrast-enhanced chest computed tomography (CT), and its prevalence has been reported to range between 1% and 15%.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e Moreover, beyond being merely a radiological diagnosis, iPTE may represent an indicator of poor cancer prognosis, and further investigation of malignancy is recommended in patients with iPTE.\u003csup\u003e[\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e Although studies have evaluated the prognosis of iPTE, there is no standardized management algorithm.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e It has also been suggested that the risk factors and clinical characteristics of iPTE may differ from those of sPTE.\u003c/p\u003e \u003cp\u003eIn incidental PTE, the absence of prominent symptoms often leads to a diagnosis being made during staging or follow-up CT performed for another disease.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e However, it remains unclear whether these patients have a better clinical course than those with sPTE.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Although some studies have reported that survival in patients with iPTE is similar to that in symptomatic cases\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, others have suggested that the risk of mortality may be lower.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e The factors that may cause clinical and prognostic differences between the two groups are still under debate.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e There is no consensus regarding the treatment approach. Some guidelines recommend managing iPTE similar to sPTE; however, the necessity of this approach in non-oncological patient populations remains controversial.\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to compare patients diagnosed with iPTE and sPTE who presented to our clinic in terms of clinical, radiological, and laboratory findings as well as mortality and disease course.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Patient Population\u003c/h2\u003e \u003cp\u003e The study was approved by the local institutional ethics committee and conducted in accordance with the Declaration of Helsinki. The requirement for informed consent was waived due to the retrospective design.\u003c/p\u003e \u003cp\u003ePatients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years who were diagnosed with acute PTE confirmed by chest computed tomography pulmonary angiography (CTPA) between January 2022 and January 2025 and whose clinical, laboratory, and radiological data were available were included in the study. Patients with a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), detected chronic thrombus, inadequate chest CT image quality, or diagnosed by ventilation\u0026ndash;perfusion scintigraphy were excluded from the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCollection of Data and Variables\u003c/h3\u003e\n\u003cp\u003ePatient data were retrieved from the hospital automation systems. PTE diagnosis in all patients was confirmed based on CTPA findings. All CTPA images, radiology reports, and indications for imaging requests were reviewed. Radiologically, thrombus laterality (unilateral or bilateral) and pulmonary artery localization (main pulmonary artery trunk, right and left main pulmonary arteries, and lobar, segmental, and subsegmental) were recorded.\u003c/p\u003e \u003cp\u003eDemographic characteristics, dates of PTE diagnosis, presence of symptoms, comorbidities, hemodynamic stability status, laboratory parameters, oxygen saturation levels, length of hospital stay, anticoagulation regimens, need for intensive care, and dates of death of patients who were not alive at the time of data collection were recorded.\u003c/p\u003e \u003cp\u003e Right ventricular assessment, classification of PTE-related clinical risk factors, and determination of acute mortality risk groups were performed based on the definitions and algorithms of the 2019 ESC/ERS acute pulmonary embolism guideline published in line with the joint recommendations of the European Society of Cardiology and the European Respiratory Society.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eDefinition and Classification\u003c/h3\u003e\n\u003cp\u003ePatients diagnosed with PTE were divided into two groups based on the clinical findings at presentation and indications for imaging. Patients who presented with acute symptoms, such as dyspnea, chest pain, tachycardia, hemoptysis, syncope, or hypoxemia, and in whom thrombus was detected on CTPA were classified as sPTE. Patients without suspicion of PTE, in whom filling defects in the pulmonary arteries were incidentally detected on imaging performed for oncological staging, infection evaluation, or other clinical reasons, and who did not report PTE-specific symptoms, were included in the iPTE group.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and categorical variables as percentages (%). Student\u0026rsquo;s t-test or Mann\u0026ndash;Whitney U test was used for comparisons between groups, while the chi-square test or Fisher\u0026rsquo;s exact test was used for categorical data. Cox regression analysis and Kaplan\u0026ndash;Meier survival curves were generated to identify the factors affecting mortality. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 306 patients with a mean age of 64.9\u0026thinsp;\u0026plusmn;\u0026thinsp;16.94 years, including 172 women (56.2%), were included in the study; of these, 264 (86.3%) were in the sPTE group and 42 (13.7%) were in the iPTE group. In terms of comorbidity distribution, the presence of at least one comorbid disease (p\u0026thinsp;=\u0026thinsp;0.023) and cancer (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were more frequent in the iPTE group, whereas chronic respiratory disease was more common in the sPTE group (p\u0026thinsp;=\u0026thinsp;0.049). A history of immobilization or surgery within the previous four weeks was more frequent in the iPTE group (p\u0026thinsp;=\u0026thinsp;0.038). The detailed demographic, clinical, comorbidity, and treatment characteristics of the patients are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics, Comorbidities, Clinical Findings, and Treatment Approaches\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll Patients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;306)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003esPTE\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eiPTE\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172 (56.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (58.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (Years) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;16.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.56\u0026thinsp;\u0026plusmn;\u0026thinsp;17.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.43\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eVital Findings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFever (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeart rate (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;19.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.62\u0026thinsp;\u0026plusmn;\u0026thinsp;19.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.40\u0026thinsp;\u0026plusmn;\u0026thinsp;16.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeart rate\u0026thinsp;\u0026gt;\u0026thinsp;110 bpm n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSBP (mmHg) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u0026thinsp;\u0026plusmn;\u0026thinsp;23.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123.93\u0026thinsp;\u0026plusmn;\u0026thinsp;23.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123.22\u0026thinsp;\u0026plusmn;\u0026thinsp;17.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDBP (mmHg) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;12.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.63\u0026thinsp;\u0026plusmn;\u0026thinsp;12.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystolic BP\u0026thinsp;\u0026lt;\u0026thinsp;100 mmHg n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (6.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (7.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory Rate\u0026thinsp;\u0026gt;\u0026thinsp;30/min (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (7.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (8.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulse sPO2 (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulse sPO2\u0026thinsp;\u0026lt;\u0026thinsp;90 n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (9.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eComorbidity n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAny comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263 (85.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e222 (84.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 (97.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (69.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (9.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic Lung Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (7.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKBY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (3.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurological Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (11.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.431\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (4.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eClinical Characteristics\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDVT Symptoms and Signs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTachycardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmobilization \u0026ndash; Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (48.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125 (47.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (52.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistory of DVT or PTE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemoptysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (4.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (4.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMental Change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (3.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (3.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemodynamic instability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (8.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (9.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (7.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eClinical outcomes\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (4.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (1.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e227 (86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (76.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (2.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.00%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (8.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (9.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLength of hospital stay (Day) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAnticoagulant Therapy\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWarfarin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (4.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDMAH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (52.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDOAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThrombolytic Therapy n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (3.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall survival (Months) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;17.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.82\u0026thinsp;\u0026plusmn;\u0026thinsp;17.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.37\u0026thinsp;\u0026plusmn;\u0026thinsp;15.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen PTE-related risk factors and clinical risk classifications were evaluated, the proportion of patients without risk factors was higher in the sPTE group than in the iPTE group, whereas the proportion of patients with intermediate-risk factors was lower (p\u0026thinsp;=\u0026thinsp;0.004). In the 30-day mortality risk assessment, the proportion of patients with intermediate\u0026ndash;low risk was higher in the iPTE group, while the proportion of patients with intermediate\u0026ndash;high and high risk was lower (p\u0026thinsp;=\u0026thinsp;0.019). The detailed results are presented in \u003cb\u003eSupplementary Table S1\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eEchocardiographic findings showed that the presence of pulmonary hypertension (PH) (p\u0026thinsp;=\u0026thinsp;0.001), mean pulmonary artery systolic pressure (PASP) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and right ventricular dysfunction were lower in the iPTE group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Radiological evaluation revealed that involvement of the main pulmonary artery was higher in the iPTE group (p\u0026thinsp;=\u0026thinsp;0.025). The presence of bilateral pulmonary artery involvement at any level was lower in the iPTE group (p\u0026thinsp;=\u0026thinsp;0.016). In the iPTE group, the presence of parenchymal infarction (p\u0026thinsp;=\u0026thinsp;0.028), mean number of infarcted segments (p\u0026thinsp;=\u0026thinsp;0.001), and rate of embolism-related pleural effusion were lower (p\u0026thinsp;=\u0026thinsp;0.026). The detailed echocardiographic and imaging findings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEchocardiographic and Radiological Imaging Findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll Patients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;306)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003esPTE\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eiPTE\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eECO Findings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary HT n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195 (63.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174 (65.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePASP (mmHg) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37,\u0026plusmn;15.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.28\u0026thinsp;\u0026plusmn;\u0026thinsp;15.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight Ventricular Finding n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (9.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"11\" rowspan=\"12\"\u003e \u003cp\u003eThrombus Localization\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMain Pulmonary Artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (1.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (9.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight Main Pulmonary Artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft Main Pulmonary Artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral Main Pulmonary Arteries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMain Pulmonary Artery (Right or left)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (45.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123 (46.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnilateral Segmentary PA Branches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral Segmentary PA Branches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181 (59.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (61.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSegmental PA Branches (Right or Left)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277 (90.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e238 (90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (92.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnilateral Subsegmental PA Branches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral Subsegmental PA Branches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165 (53.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (57.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubsegmental PA Branches (Right or Left)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e234 (76.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208 (78.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral PA Branches (Any level)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e238 (77.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e236 (89.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (76.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePatients with Parenchymal Infarction n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (39.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of Infarcted Segments (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePleural Fluid Due to Embolism n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (9.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLower extremity DVT n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen hematological and biochemical parameters were evaluated, the iPTE group had lower mean leukocyte counts (p\u0026thinsp;=\u0026thinsp;0.003), hemoglobin levels (p\u0026thinsp;=\u0026thinsp;0.021), and mean C-reactive protein (CRP) levels (p\u0026thinsp;=\u0026thinsp;0.002), while the mean procalcitonin (PCT) level was higher (p\u0026thinsp;=\u0026thinsp;0.002). The detailed results of the hematological, biochemical, and cardiac parameters are presented in \u003cb\u003eSupplementary Table S2\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eIn the Kaplan\u0026ndash;Meier survival analyses, there was no significant difference in survival between iPTE and sPTE (p\u0026thinsp;=\u0026thinsp;0.346) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) or between bilateral and unilateral PTE (p\u0026thinsp;=\u0026thinsp;0.067) (\u003cb\u003eSupplementary Fig. S1\u003c/b\u003e). In contrast, survival was lower in patients with acute lower extremity DVT (deep vein thrombosis) (p\u0026thinsp;=\u0026thinsp;0.011), elevated TnT levels (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), admission sPO₂ \u0026lt; 90% (p\u0026thinsp;=\u0026thinsp;0.020), and tachycardia (p\u0026thinsp;=\u0026thinsp;0.009) (\u003cb\u003eSupplementary Figs. S2\u0026ndash;S5\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe overall model was statistically significant in the Cox regression analysis (omnibus test: χ\u0026sup2; = 26.674; df\u0026thinsp;=\u0026thinsp;5; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A history of cancer (HR\u0026thinsp;=\u0026thinsp;3.067; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and elevated TnT levels (HR\u0026thinsp;=\u0026thinsp;2.704; p\u0026thinsp;=\u0026thinsp;0.002) significantly increased the risk of mortality. In contrast, bilateral involvement (HR\u0026thinsp;=\u0026thinsp;0.502; p\u0026thinsp;=\u0026thinsp;0.070), PASP (HR\u0026thinsp;=\u0026thinsp;0.996; p\u0026thinsp;=\u0026thinsp;0.695), and iPTE (HR\u0026thinsp;=\u0026thinsp;1.201; p\u0026thinsp;=\u0026thinsp;0.630) did not significantly affect mortality (\u003cb\u003eSupplementary Fig. S6\u003c/b\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study indicate that patients with iPTE have a higher comorbidity burden than those with sPTE, thrombi are located in more proximal branches, parenchymal infarction develops less frequently, and echocardiographic findings are milder. However, no significant difference in survival duration was observed between the two groups.\u003c/p\u003e \u003cp\u003ePrevious studies have reported that patients with iPTE exhibit a milder phenotype, with lower PESI scores, less central embolism, and less right ventricular dilatation on CT.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e In the present study, the Wells scores and short-term mortality risk classifications were also lower in the iPTE group. However, in pulmonary embolism, in addition to clinical scoring systems, TnT, BNP, and right ventricular dysfunction are key prognostic tools for predicting short-term mortality.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e Scores such as the Hull-CPR, which are based on ECOG performance status and symptom profile, aim to identify a vulnerable phenotype beyond the classical PESI/Wells approach, particularly in cancer patients.\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e Despite the lower clinical risk scores in iPTE cases, the high burden of malignancy and comorbidities suggests that individualized approaches incorporating performance status and treatment intensity should be integrated into the clinical decision-making process.\u003c/p\u003e \u003cp\u003eThe lower frequency of pulmonary hypertension, lower PASP values, and fewer RV strain findings in the iPTE group than in the sPTE group support the idea that incidental cases have a hemodynamically milder phenotype. Studies have also reported that central embolism, RV dilatation, and short-term adverse events are less frequent in iPTE.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e In cancer-associated iPTE, centrally located emboli have been shown to be associated with a poorer prognosis.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e The lower PASP and RV strain findings in the iPTE cases may be explained by the predominance of a more peripheral or limited embolic burden. As recommended by current guidelines, the assessment of clinical scores, together with TnT/BNP levels and RV dysfunction, provides comprehensive risk stratification for short-term mortality.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e Peris et al. demonstrated that VTE recurrence and major bleeding rates may be similar between iPTE and sPTE, emphasizing that these patients should not be underestimated despite low-risk scores.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe impact of embolus localization on prognosis has been reported in different studies; prognosis in proximal iPTE has been shown to be like that in sPTE, whereas in SSPE, embolus size and number have not been shown to have a significant effect on mortality.\u003csup\u003e[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e With the widespread use of multidetector CTPA, the increased diagnosis of PTE has led to more frequent detection of clinically insignificant SSPE and to discussions of \u0026ldquo;overdiagnosis\u0026rdquo; in iPTE.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e Therefore, the treatment approach for iPTE remains controversial, and individualized treatment is recommended in SSPE cases by considering the presence of DVT, symptom status, and bleeding risk.\u003csup\u003e[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e Armitage et al. reported that a \u0026ldquo;surveillance and DVT screening\u0026rdquo; strategy may be appropriate for SSPE.\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict\u003c/strong\u003e \u003cp\u003eing results exist in the literature regarding radiological phenotypes. Some studies have reported that iPTE is located more distally and unilaterally, whereas others have shown an association with more proximal emboli and lower mortality.\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e Although central emboli in cancer-associated iPTE have been reported to be associated with poorer survival, some studies have demonstrated better overall survival despite a high rate of central involvement.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e These findings suggest that prognosis depends not only on thrombus localization but also on the total clot burden and bilaterality. In our study, the presence of more widespread bilateral thrombus, pulmonary infarction, and pleural effusion in the sPTE group indicated a more severe clinical phenotype, whereas the more limited clot burden and less parenchymal damage in the iPTE group suggested that incidental detection may reflect an earlier disease stage.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eLower CRP and leukocyte levels and higher PCT levels in the iPTE group suggested that the inflammatory response may differ between the two types of PTE. In our previous study, elevated CRP levels and fever were more frequent in patients with PTE with pulmonary infarction.\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e Accordingly, the higher CRP and leukocyte levels observed in the sPTE group supported an acute inflammatory phenotype. The elevated PCT level observed in iPTE may reflect a vulnerable patient profile associated with malignancy-related systemic inflammation and metabolic stress rather than infection.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLower TnT and BNP levels in the iPTE group indicated a milder clinical picture in terms of right ventricular pressure load and myocardial stress. This finding is consistent with the literature demonstrating the prognostic value of cardiac biomarkers in PTE.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e Moreover, radiologically proximal, or central emboli have been reported to be associated with more pronounced RV strain and poorer survival.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e The identification of elevated TnT levels as an independent predictor of mortality in our Cox regression analysis further supports this association.\u003c/p\u003e \u003cp\u003eIn the literature, iPTE has been reported to be associated with a better prognosis in some series\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, whereas in others, it has been associated with similar or even worse outcomes, particularly in patients with cancer.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e This heterogeneity suggests that survival is determined more by the clinical and biological burden of the patient than by the mode of embolus detection. In iPTE, mortality often results not from the embolism itself, but from cancer biology, performance status, and frailty.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e Accordingly, the similar survival observed between iPTE and sPTE in our study and the identification of cancer history and elevated TnT levels as determinants of mortality indicate that prognosis is primarily driven by malignancy and hemodynamic stress.\u003c/p\u003e \u003cp\u003eThe higher rate of outpatient follow-up in the iPTE group and the longer hospitalization duration in the sPTE group highlight the differences in clinical management requirements between the two groups. The literature has reported that a proportion of iPTE cases can be managed on an outpatient basis under appropriate anticoagulation\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, and this approach is also consistent with the ASH and ASCO guidelines.\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has limitations inherent to its single-center, retrospective observational design, including potential selection and information bias. The imbalance in malignancy and comorbidity burden between groups may have introduced residual confounding despite multivariable adjustment. Finally, external validity may be limited and the findings should be confirmed in larger multicenter cohorts.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIncidental pulmonary thromboembolism is associated with a lower hemodynamic and radiological burden than symptomatic cases, while demonstrating comparable survival. Mortality appears to be driven primarily by underlying clinical and biological vulnerability, particularly malignancy and myocardial stress, rather than by whether embolism is detected incidentally or symptomatically. These findings suggest that patient-based risk profiles may be more informative than the mode of PTE presentation when interpreting prognosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eF.K.: Conceptualization, study design, data analysis, interpretation of results, manuscript drafting, and final approval.\u003c/p\u003e\n\u003cp\u003eC.D.: Statistical analysis, and critical revision of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026Ouml;.D.: Supervision, study oversight, critical revision of the manuscript, and final approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ko\u0026ccedil; University Clinical Research Ethics Committee, Ko\u0026ccedil; University, İstanbul, T\u0026uuml;rkiye (Decision No: 2025.616.IRB1.089). Due to the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch3 id=\"_Toc472330565\"\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003ch3 id=\"_Toc472330566\"\u003e\u003cstrong\u003eFunding Sources\u003c/strong\u003e\u003c/h3\u003e\n\u003cp id=\"_Toc472330568\"\u003eThis study received no specific funding from any public, commercial, or not-for-profit sector.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to ethical and legal restrictions related to patient confidentiality but are available from the corresponding author\u0026nbsp;upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable (retrospective observational study).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKonstantinides SV, Meyer G, Bueno H, Gali\u0026eacute; N, Gibbs JSR, Ageno W et al (2020) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J 41:543\u0026ndash;603\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKraaijpoel N, Bleker SM, Meyer G, Mah\u0026eacute; I, Mu\u0026ntilde;oz A, Bertoletti L et al (2019) Treatment and Long-Term Clinical Outcomes of Incidental Pulmonary Embolism in Patients With Cancer: An International Prospective Cohort Study. J Clin Oncol 37:1713\u0026ndash;1720\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003edos Santos Fernandes CJC, Couturaud F (2021) Moving forward for incidental pulmonary embolism in cancer patients. Eur Respir J 58:2004630\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreund Y, Cohen-Aubart F, Bloom B (2022) Acute Pulmonary Embolism: A Review. JAMA 328:1336\u0026ndash;1345\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer HJ, Wienke A, Surov A (2021) Incidental pulmonary embolism in oncologic patients\u0026mdash;a systematic review and meta-analysis. Support Care Cancer 29:1293\u0026ndash;1302\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu V, O\u0026rsquo;Connell C (2016) Management of the Incidental Pulmonary Embolism. AJR Am J Roentgenol 208:485\u0026ndash;488\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQdaisat A, Kamal M, Al-Breiki A, Goswami B, Wu CC, Zhou S et al (2020) Clinical characteristics, management, and outcome of incidental pulmonary embolism in cancer patients. Blood Adv 4:1606\u0026ndash;1614\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFont C, Cooksley T, Ahn S, Rapoport B, Escalante C (2022) Emergency management of incidental pulmonary embolism (IPE). Emerg Cancer Care 1:4\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelluc A, Wang TF (2021) How to treat incidental pulmonary embolism in cancer patients? Recent advances. Kardiol Pol 79:1305\u0026ndash;1310\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Nisio M, Carrier M (2017) Incidental venous thromboembolism: is anticoagulation indicated? Hematol Am Soc Hematol Educ Program 2017:121\u0026ndash;127\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiklund P, Medson K, Elf J (2023) Incidental pulmonary embolism in patients with cancer: prevalence, underdiagnosis and evaluation of an AI algorithm for automatic detection of pulmonary embolism. Eur Radiol 33:1185\u0026ndash;1193\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeris M, L\u0026oacute;pez-Nu\u0026ntilde;ez JJ, Maestre A, Jimenez D, Muriel A, Bikdeli B et al (2021) Clinical characteristics and 3-month outcomes in cancer patients with incidental versus clinically suspected and confirmed pulmonary embolism. Eur Respir J 58:2002723\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026ouml;nen B, Hanci P, Hatipoğlu ON (2024) Characteristics of patients with symptomatic and incidental pulmonary thromboembolism. Tuberk Toraks 72:179\u0026ndash;184\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiustozzi M, Connors JM, Ruperez Blanco AB, Szmit S, Falvo N, Cohen AT et al (2021) Clinical characteristics and outcomes of incidental venous thromboembolism in cancer patients: Insights from the Caravaggio study. J Thromb Haemost 19:2751\u0026ndash;2760\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawson P, Raskin S, Soffer S, Marom E, Berger R, Amitai MM et al (2020) Incidental pulmonary embolism in CT scans of oncological patients with metastatic disease undergoing clinical trials: frequency and linkage with onset of disease progression (PE-PD association). Br J Radiol 93:20200591\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWysokinska EM, Houghton DE, Vlazny DT, Ashrani AA, Froehling DA, Meverden R et al (2023) Incidental pulmonary embolism in cancer and noncancer patients: Prospective cohort study. Eur J Haematol 110:88\u0026ndash;98\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YH, Cha SI, Park J, Lim JK, Lee WK, Park JE et al (2023) Incidental versus symptomatic pulmonary embolism in patients without cancer. Vasc Med 28:461\u0026ndash;462\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas SE, Weinberg I, Schainfeld RM, Rosenfield K, Parmar GM (2024) Diagnosis of Pulmonary Embolism: A Review of Evidence-Based Approaches. J Clin Med 13:3722\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaraveyas A, Kraaijpoel N, Bozas G, Huang C, Mah\u0026eacute; I, Bertoletti L et al (2021) The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study. J Thromb Haemost 19:2791\u0026ndash;2800\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Liu Z, Li Q, Xia L, Wang Y, Jiang D et al (2023) Prognosis of incidental pulmonary embolism vs. symptomatic pulmonary embolism in cancer patients: a single-center retrospective cohort study in China. Thromb J 21:12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiener RS, Schwartz LM, Woloshin S (2011) Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med 171:831\u0026ndash;836\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmitage MN, Mughal AZ, Huntley CC, Lasserson D, Newnham M (2023) A multicentre observational study of the prevalence, management, and outcomes of subsegmental pulmonary embolism. J Thromb Thrombolysis 55:126\u0026ndash;133\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo Z, Xu N, Ma G, Lu Y, Yao J, Ying K (2023) Incidentally Diagnosed With Pulmonary Embolism in Lung Cancer Patients: Comparison of Clinical Characteristics and Mortality With Symptomatic Pulmonary Embolism. Clin Appl Thromb Hemost 29:10760296231212482\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDogan C, Karatas F, Samanci S, Icten S, Menek G, Parmaksiz ET et al (2025) Impact of pulmonary infarction after thromboembolism: A multicenter study. Ann Thorac Med\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishikawa T, Fujita T, Morishima T, Okawa S, Hino T, Yasui T et al (2024) Prognostic Effect of Incidental Pulmonary Embolism on Long-Term Mortality in Cancer Patients. Circ J 88:198\u0026ndash;204\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Menyar A, Sathian B, Al-Thani H (2019) Elevated serum cardiac troponin and mortality in acute pulmonary embolism: Systematic review and meta-analysis. Respir Med 157:26\u0026ndash;35\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Hulle T, den Exter PL, Planquette B, Meyer G, Soler S, Monreal M et al (2016) Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: a pooled analysis of 926 patients. J Thromb Haemost 14:105\u0026ndash;113\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA et al (2021) American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 5:927\u0026ndash;974\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKey NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI et al (2020) Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 38:496\u0026ndash;520\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary embolism, Incidental pulmonary embolism, Prognosis, Risk stratification","lastPublishedDoi":"10.21203/rs.3.rs-8695116/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8695116/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIncidental pulmonary thromboembolism (iPTE) is increasingly being detected owing to the widespread use of computed tomography; however, its clinical significance and prognostic impact compared with symptomatic pulmonary thromboembolism (sPTE) remains controversial.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThis retrospective observational study included adult patients with acute pulmonary embolism confirmed using CT pulmonary angiography between January 2022 and January 2025. Patients were classified as having iPTE or sPTE based on the clinical presentation and indications for imaging. Demographic characteristics, comorbidities, clinical findings, laboratory parameters, imaging features, and outcomes were compared between groups. Survival was assessed using Kaplan\u0026ndash;Meier analysis, and predictors of mortality were evaluated using Cox regression analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 306 patients were included, of whom 42 (13.7%) had iPTE and 264 (86.3%) had sPTE. Patients with iPTE had a higher prevalence of malignancy and comorbidities, but showed lower heart rate, higher oxygen saturation, lower cardiac biomarker levels, and less right ventricular dysfunction. Radiologically, iPTE was associated with a less extensive embolic burden and fewer parenchymal complications. The median survival did not differ significantly between the iPTE and sPTE groups (log-rank, p\u0026thinsp;=\u0026thinsp;0.346). In multivariate analysis, malignancy (hazard ratio [HR] 3.07, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and elevated troponin T (HR 2.70, p\u0026thinsp;=\u0026thinsp;0.002) were independent predictors of mortality, whereas iPTE status was not.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite a lower hemodynamic and radiological burden, incidental pulmonary thromboembolism was associated with survival comparable to that of symptomatic cases. Mortality was primarily driven by underlying malignancy and myocardial injury rather than by embolism presentation.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eNot applicable (retrospective observational study).\u003c/p\u003e","manuscriptTitle":"Incidental and Symptomatic Pulmonary Thromboembolism: Clinical Features and Prognostic Comparison","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 10:29:57","doi":"10.21203/rs.3.rs-8695116/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2c5788fb-e4c2-4d6c-a308-ade2b369f57f","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61723394,"name":"Pulmonology"}],"tags":[],"updatedAt":"2026-01-27T10:29:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-27 10:29:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8695116","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8695116","identity":"rs-8695116","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}