Protease-activated receptor 1 as a potential therapeutic target for COVID-19.

Acute respiratory disease caused by a novel coronavirus (SARS-CoV-2) has spread all over the world, since its discovery in 2019, Wuhan, China. This disease is called COVID-19 and already killed over 1 million people worldwide. The clinical symptoms include fever, dry cough, dyspnea, headache, dizziness, generalized weakness, vomiting, and diarrhea. Unfortunately, so far, there is no validated vaccine, and its management consists mainly of supportive care. Venous thrombosis and pulmonary embolism are highly prevalent in patients suffering from severe COVID-19. In fact, a prothrombotic state seems to be present in most fatal cases of the disease. SARS-CoV-2 leads to the production of proinflammatory cytokines, causing immune-mediated tissue damage, disruption of the endothelial barrier, and uncontrolled thrombogenesis. Thrombin is the key regulator of coagulation and fibrin formation. In severe COVID-19, a dysfunctional of physiological anticoagulant mechanisms leads to a progressive increase of thrombin activity, which is associated with acute respiratory distress syndrome development and a poor prognosis. Protease-activated receptor type 1 (PAR1) is the main thrombin receptor and may represent an essential link between coagulation and inflammation in the pathophysiology of COVID-19. In this review, we discuss the potential role of PAR1 inhibition and regulation in COVID-19 treatment.

Concordance between clinical diagnosis of pulmonary thromboembolism at hospital discharge and anatomopathological diagnosis.

Half of the cases of pulmonary thromboembolism (PTE) are not diagnosed because of its unspecific clinical presentation; in Mexico, autopsy data reveal a similar incidence to that of developed countries. The objective of this work was to know the concordance between the clinical diagnosis of PTE at hospital discharge and its autopsy diagnosis. The method used was a retrospective cohort study of cases with PTE diagnosis who attended from January 2005 to December 2013. Information was obtained from the autopsies registry and clinical charts. From 177,368 hospital discharges, there were 412 (6.74%) with PTE diagnosis. There were 13,559 deaths, with PTE diagnosis in 139 (1%) patients. There were 479 autopsies, and in 66 (14%) of whom PTE diagnosis was documented, the mean age was 55 years (range, 18-89 years). The premortem diagnosis of PTE at discharge was confirmed in 412 cases. Postmortem diagnosis of principal disease was medical in 49 (74%) and medical-surgical in 17 (26%) patients. We found that nine patients had the clinical diagnosis of PTE, unlike the postmortem diagnosis, which was reported in 66 autopsies. The above allows establishing a 1:7 ratio that represents 14%. D-dimer was determined in 11 cases (16%) and was positive in 8 (73%). Thromboprophylaxis was applied in 15 cases (23%). The study of necropsies and identification of discrepancies is needed to improve the diagnostic accuracy and healthcare quality. The evaluation of hemostasis biomarkers besides D-dimer can better describe the pro-thrombotic state, the risk of thrombosis, and its association with morbidity and mortality.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Thrombosis: Phlegmasia Cerulea Dolens Presenting with Venous Gangrene in a Child.

A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive pulmonary embolism and cardiac arrest, for which extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia were used. Staged ultrasound-assisted catheter-directed thrombolysis was used for treatment of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received extracorporeal membrane oxygenation support. We highlight the need for heightened suspicion for occult severe acute respiratory syndrome coronavirus 2 infection among children presenting with unusual thrombotic complications.

[Pulmonary embolism. Clinical suspicion and anatomopathological correlation]. / Tromboembolismo de pulmón. Sospecha clínica y correlación anatomopatológica.

Discrepancies between clinical suspicion and pathological findings in pulmonary embolism (PE) appear to be frequent. The aim of this study was to analyze the prevalence of PE in a necropsy series of patients who have died in an acute care hospital between 1998-2017, its relationship with previous clinical suspicion, and its importance as a cause of death. It is a retrospective observational study of 350 autopsies done at the Department of Pathology. We analyzed the demographic characteristics, main clinical diagnoses stated in the autopsy request form, incidence of PE diagnosed, main autopsy findings related with the cause of death, as well as the concordance between clinical suspicion and autopsy diagnosis. In only 8% of the cases (n = 28) the clinical diagnosis of autopsy request was PE. An autopsy diagnosis of PE was done in 127 cases (36.3%); in 33 cases (25.9%) affected large pulmonary vessels; medium caliber vessels were affected in 75 cases (59.1%), and in 19 cases small vessels. The PE was considered as a contributor or cause of death in 30.9% (n = 108). However, only 15.7% of the confirmed PE cases had previous clinical suspicion. This series of necropsies shows that PE is a high prevalence finding in autopsies at an acute care hospital, and an important cause of death in a 20 years period. The finding of a low concordance with clinical diagnosis should alert the medical community on the importance of clinical suspicion in order to achieve an early diagnosis and treatment of this disease.

Las discrepancias entre la sospecha clínica y los hallazgos patológicos en el tromboembolismo pulmonar (TEP) son frecuentes. El objetivo de este estudio fue analizar la prevalencia de TEP en una serie de necropsias de fallecidos en un hospital general de agudos entre 1998 y 2017, su relación con la sospecha clínica y su importancia como causa de muerte. Es un estudio retrospectivo y observacional de 350 autopsias realizadas en el Servicio de Patología; analiza características demográficas, principales diagnósticos clínicos informados en la solicitud de autopsia (sospecha clínica de muerte), incidencia anatomopatológica de TEP, diagnósticos primarios de autopsia relacionados con la muerte y concordancia entre sospecha clínica y diagnósticos de autopsia. En solo el 8% de las autopsias (n = 28), el TEP fue el diagnóstico clínico informado. En las autopsias, se encontró TEP en 127 casos (36.3%). Afectó arterias pulmonares grandes en 33 casos (25.9%), vasos medianos en 75 (59.1%) y vasos pequeños en 19 casos. El TEP se consideró el principal contribuyente o la causa principal de muerte en un 30.9% (n = 108) de los casos. Sin embargo, solo en el 15.7% de los casos confirmados había una sospecha clínica previa de TEP. Esta serie muestra que el TEP es un hallazgo de alta prevalencia y una causa importante de muerte en autopsias realizadas en un hospital de agudos. La evidencia de la baja concordancia entre los diagnósticos anatomopatológicos y clínicos del TEP alerta sobre la importancia de la sospecha clínica para lograr un tratamiento temprano de la enfermedad.

Tromboembolismo de pulmón: Sospecha clínica y correlación anatomopatológica / Pulmonary embolism. Clinical suspicion and anatomopathological correlation

Las discrepancias entre la sospecha clínica y los hallazgos patológicos en el tromboembolismo pulmonar (TEP) son frecuentes. El objetivo de este estudio fue analizar la prevalencia de TEP en una serie de necropsias de fallecidos en un hospital general de agudos entre 1998 y 2017, su relación con la sospecha clínica y su importancia como causa de muerte. Es un estudio retrospectivo y observacional de 350 autopsias realizadas en el Servicio de Patología; analiza características demográficas, principales diagnósticos clínicos informados en la solicitud de autopsia (sospecha clínica de muerte), incidencia anatomopatológica de TEP, diagnósticos primarios de autopsia relacionados con la muerte y concordancia entre sospecha clínica y diagnósticos de autopsia. En solo el 8% de las autopsias (n = 28), el TEP fue el diagnóstico clínico informado. En las autopsias, se encontró TEP en 127 casos (36.3%). Afectó arterias pulmonares grandes en 33 casos (25.9%), vasos medianos en 75 (59.1%) y vasos pequeños en 19 casos. El TEP se consideró el principal contribuyente o la causa principal de muerte en un 30.9% (n = 108) de los casos. Sin embargo, solo en el 15.7% de los casos confirmados había una sospecha clínica previa de TEP. Esta serie muestra que el TEP es un hallazgo de alta prevalencia y una causa importante de muerte en autopsias realizadas en un hospital de agudos. La evidencia de la baja concordancia entre los diagnósticos anatomopatológicos y clínicos del TEP alerta sobre la importancia de la sospecha clínica para lograr un tratamiento temprano de la enfermedad.

Discrepancies between clinical suspicion and pathological findings in pulmonary embolism (PE) appear to be frequent. The aim of this study was to analyze the prevalence of PE in a necropsy series of patients who have died in an acute care hospital between 1998-2017, its relationship with previous clinical suspicion, and its importance as a cause of death. It is a retrospective observational study of 350 autopsies done at the Department of Pathology. We analyzed the demographic characteristics, main clinical diagnoses stated in the autopsy request form, incidence of PE diagnosed, main autopsy findings related with the cause of death, as well as the concordance between clinical suspicion and autopsy diagnosis. In only 8% of the cases (n = 28) the clinical diagnosis of autopsy request was PE. An autopsy diagnosis of PE was done in 127 cases (36.3%); in 33 cases (25.9%) affected large pulmonary vessels; medium caliber vessels were affected in 75 cases (59.1%), and in 19 cases small vessels. The PE was considered as a contributor or cause of death in 30.9% (n = 108). However, only 15.7% of the confirmed PE cases had previous clinical suspicion. This series of necropsies shows that PE is a high prevalence finding in autopsies at an acute care hospital, and an important cause of death in a 20 years period. The finding of a low concordance with clinical diagnosis should alert the medical community on the importance of clinical suspicion in order to achieve an early diagnosis and treatment of this disease.

Searching for the Best Way to Assess the Risk of Thrombosis in Aesthetic Plastic Surgery; The Role of the Caprini/Pannucci Score.

INTRODUCTION: There is concern regarding the high incidence of thrombosis in plastic surgery patients. For this reason, we wanted to compare the results of the Caprini/Pannucci score in patients with and without a past history of thrombosis admitted for aesthetic plastic surgery. METHODS: This was a case-control study of 152 patients undergoing aesthetic plastic surgery procedures. We formed two groups: Group I had 70 patients who had thrombosis after aesthetic plastic surgery and group II had 82 patients without thrombosis. We studied the considered risk factors for thrombosis. We weighted the factors according to the OR and linear regressions. We then related them to the Caprini/Pannucci score. RESULTS: Patients in group I had a score of 5.68 versus 3.45 in group II (p < 0.001). There was a 9.86% increase in thrombosis for each increased point in the rating. A higher effectiveness of the Caprini score was found in the high-score group; the greatest flaw was in the low-scoring group. The sensitivity was 75.71%, and the specificity was 70.73%. The factors with the greatest impact were the infiltration of fat in the buttocks, degree of obesity and time of surgery. There was an increased risk of thrombosis in patients with gluteal fat injections, varicose veins, obesity and immune disorders as well as those who had previously given birth. CONCLUSION: To increase the effectiveness of the score and to use the score as a basis on which to decide upon prophylactic care, it is necessary to modify the score and add some factors. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pulmonary thromboembolism secondary to pelvic thrombosis related to giant ovarian tumor

Pulmonary thromboembolism (PTE) is one of the major complications in oncologic patients. The incidence of PTE in these cases is 4 to 7 times higher than in non-oncologic patients. Ovarian tumors, specifically those of large sizes, may impair the blood flow through the pelvic veins as tumor pressure over the pelvic vessels increases the incidence of thrombosis. The authors report the case of the unexpected death of a 74-year-old female due to massive pulmonary thromboembolism, associated with an ovarian tumor almost of 15 kg of weight that filled the abdominal and pelvic cavities. The compressive effect on the walls of the pudendal and periuterine veins somehow facilitated the local thrombosis. According to the histological characterization on post-mortem samples, the mass was identified as an "atypical proliferative (borderline) mucinous tumor." The case emphasizes the important association between pulmonary thromboembolism and ovarian tumors

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries.

OBJECTIVE: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. METHODS: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). RESULTS: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. CONCLUSIONS: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries / Incidência e características morfológicas do sinal do halo invertido em pacientes com tromboembolismo pulmonar agudo e infarto pulmonar submetidos a angiotomografia de artérias pulmonares

ABSTRACT Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

RESUMO Objetivo: Verificar a incidência do sinal do halo invertido (SHI) associado a infartos pulmonares (IP) relacionados ao tromboembolismo pulmonar (TEP) agudo, identificado por angiotomografia (angio-TC) de artérias pulmonares, e demonstrar as principais características morfológicas do SHI. Métodos: Foram avaliadas 993 angio-TCs, após estratificação de risco clínico para TEP entre janeiro de 2010 e dezembro de 2014. TEP foi encontrado em 164 pacientes (16,5%), sendo que três exames foram descartados devido a artefatos de movimentação respiratória. Dos 161 exames restantes, em 75 (46,6%) foram identificadas imagens compatíveis com IP, totalizando 86 lesões; o SHI foi observado em 33 (38,4% dos pacientes) dessas lesões. Resultados: Dos 29 pacientes com lesões características de IP com o SHI, 25 pacientes (86,2%) apresentavam lesão única e 4 (13,8%), lesão dupla. Todas as imagens compatíveis com SHI eram de localização subpleural. Para padronizar a análise, todas as imagens foram interpretadas no plano axial. Em relação à distribuição lobar das 33 lesões, o SHI estava localizado no lobo inferior direito, em 17 (51,5%); no lobo inferior esquerdo, em 10 (30,3%); na língula, em 5 (15,2%) e no lobo superior direito, em 1 (3,0%). Áreas de baixa atenuação no interior dos IPs com o SHI foram observadas em 29 das 33 lesões (87,9%). O SHI apresentava formato ovalado em 24 (72,7%) dos casos e formato arredondado, em 9 (27,3%). Derrame pleural foi encontrado associado aos IP com o SHI em 21 pacientes (72,4%). Conclusões: O achado de imagens com essas características, mesmo em pacientes com sintomatologia inespecífica, deve alertar para a possibilidade do diagnóstico de TEP.

Correlations of inhaled NO with the cTnI levels and the plasma clotting factor in rabbits with acute massive pulmonary embolism.

PURPOSE: To investigate the correlation of inhaled nitric oxide (NO) on plasma levels of cardiac troponin I (cTnI) and von Willebrand factor (vWF), glycoprotein (GP) IIb/IIIa, granule membrane protein 140 (GMP-140) in rabbits with acute massive pulmonary embolism (PE). METHODS: Thirty apanese white rabbits were divided into 3 groups, thrombus were injected in model group (n = 10), NO were inhalated for 24 h after massive PE in NO group (n = 10), saline were injected in control group (n = 10). The concentrations of vWF, GP IIb/IIIa, GMP-140 and cTnI were tested at 4, 8, 12, 16, 20, and 24 h, Correlation analyses were conducted between cTnI and vWF, GP IIb/IIIa, and GMP-140 by Pearson's correlation. RESULTS: The concentration of cTnI and vWF, GP IIb/IIIa, and GMP-140 was increased in the model group, compared to control group. In the inhaled group, the concentrations of cTnI, vWF, GP IIb/IIIa, and GMP-140 were reduced compared to model group. There was a positive correlation between cTnI and vWF, GP IIb/IIIa, and GMP-140. CONCLUSION: Inhaled nitric oxide can lead to a decrease in levels of cardiac troponin I, von Willebrand factor, glycoprotein, and granule membrane protein 140, after an established myocardial damage, provoked by acute massive pulmonary embolism.

The effects of inhaled NO on plasma vasoactive factor and CTnI level in rabbits with acute massive pulmonary embolism1.

PURPOSE: To investigate changes in the plasma concentrations of cardiac troponin I (CTnI), thromboxane A2 (TXA2), prostaglandin I2 (PGI2) and endothelin-1 (ET-1) in rabbits with massive pulmonary embolism (AMPE) and the impact of nitric oxide inhalation (NOI) on these indices. METHODS: A total of 30 Japanese rabbits were used to construct an MPE model and were divided into 3 groups equally (n=10), including an EXP group (undergoing modeling alone), an NOI group (receiving NOI 2 h post-modeling) and a CON group (receiving intravenous physiological saline). RESULTS: In the model group, plasma concentration of CTnI peaked at 16 h following modeling (0.46±0.10 µg/ml) and significantly decreased following NOI. Plasma levels of TXB2, PGI2 and ET-1 peaked at 12, 16 and 8 h following modeling, respectively, and significantly decreased at different time points (0, 2, 4, 8, 12, 16, 20 and 24 h) following NOI. A significant correlation was observed between the peak plasma CTnI concentration and peak TXB2, 6-keto prostaglandin F1α and ET-1 concentrations in the model and NOI groups. CONCLUSION: Increases in plasma TXA2, PGI2 and ET-1 levels causes myocardial damage in a rabbit model of AMPE; however, NOI effectively down regulates the plasma concentration of these molecules to produce a myocardial-protective effect.

Correlations of inhaled NO with the cTnI levels and the plasma clotting factor in rabbits with acute massive pulmonary embolism

Abstract Purpose: To investigate the correlation of inhaled nitric oxide (NO) on plasma levels of cardiac troponin I (cTnI) and von Willebrand factor (vWF), glycoprotein (GP) IIb/IIIa, granule membrane protein 140 (GMP-140) in rabbits with acute massive pulmonary embolism (PE). Methods: Thirty apanese white rabbits were divided into 3 groups, thrombus were injected in model group (n = 10), NO were inhalated for 24 h after massive PE in NO group (n = 10), saline were injected in control group (n = 10). The concentrations of vWF, GP IIb/IIIa, GMP-140 and cTnI were tested at 4, 8, 12, 16, 20, and 24 h, Correlation analyses were conducted between cTnI and vWF, GP IIb/IIIa, and GMP-140 by Pearson's correlation. Results: The concentration of cTnI and vWF, GP IIb/IIIa, and GMP-140 was increased in the model group, compared to control group. In the inhaled group, the concentrations of cTnI, vWF, GP IIb/IIIa, and GMP-140 were reduced compared to model group. There was a positive correlation between cTnI and vWF, GP IIb/IIIa, and GMP-140. Conclusion: Inhaled nitric oxide can lead to a decrease in levels of cardiac troponin I, von Willebrand factor, glycoprotein, and granule membrane protein 140, after an established myocardial damage, provoked by acute massive pulmonary embolism.

The effects of inhaled NO on plasma vasoactive factor and CTnI level in rabbits with acute massive pulmonary embolism

Abstract Purpose: To investigate changes in the plasma concentrations of cardiac troponin I (CTnI), thromboxane A2 (TXA2), prostaglandin I2 (PGI2) and endothelin-1 (ET-1) in rabbits with massive pulmonary embolism (AMPE) and the impact of nitric oxide inhalation (NOI) on these indices. Methods: A total of 30 Japanese rabbits were used to construct an MPE model and were divided into 3 groups equally (n=10), including an EXP group (undergoing modeling alone), an NOI group (receiving NOI 2 h post-modeling) and a CON group (receiving intravenous physiological saline). Results: In the model group, plasma concentration of CTnI peaked at 16 h following modeling (0.46±0.10 µg/ml) and significantly decreased following NOI. Plasma levels of TXB2, PGI2 and ET-1 peaked at 12, 16 and 8 h following modeling, respectively, and significantly decreased at different time points (0, 2, 4, 8, 12, 16, 20 and 24 h) following NOI. A significant correlation was observed between the peak plasma CTnI concentration and peak TXB2, 6-keto prostaglandin F1α and ET-1 concentrations in the model and NOI groups. Conclusion: Increases in plasma TXA2, PGI2 and ET-1 levels causes myocardial damage in a rabbit model of AMPE; however, NOI effectively down regulates the plasma concentration of these molecules to produce a myocardial-protective effect.

Thromboembolic findings in patients with heart failure at autopsy.

BACKGROUND: The risk of thromboembolic events is increased in patients with heart failure (HF); however, few studies have reported thromboembolic findings in HF patients who have undergone autopsy. METHODS AND RESULTS: We reviewed 1457 autopsies (January 2000/July 2006) and selected 595 patients with HF. We studied the occurrence of thromboembolic events in patients' autopsy reports. Mean age was 61.8±15.9 years; 376 (63.2%) were men and 219 (36.8%) women; left ventricular ejection fraction was 42.1±18.7%. HF etiologies were coronary artery disease in 235 (39.5%) patients, valvular disease in 121 (20.3%), and Chagas' disease in 81 (13.6%). The main cause of death was progressive HF in 253 (42.5%) patients, infections in 112 (18.8%), myocardial infarction in 86 (14.5%), and pulmonary embolism in 81 (13.6%). Altogether, 233 patients (39.2%) suffered 374 thromboembolic events. A thromboembolic event was considered the direct cause of death in 93 (24.9%) patients and related to death in 158 (42.2%). The most frequent thromboembolism was pulmonary embolism in 135 (36.1%) patients; in 81 events (60%), it was considered the cause of death. When we compared clinical characteristics of patients, sex (OR=1.511, CI 95% 1.066-2.143, P=.021) and Chagas disease (OR=2.362, CI 95% 1.424-3.918, P=.001) were independently associated with the occurrence of thromboembolisms. CONCLUSIONS: Thromboembolic events are frequent in patients with heart failure revealed at autopsy, and are frequently associated with the death process. Our findings warrant a high degree of suspicion for these occurrences, especially during the care of more susceptible populations, such as women and Chagas patients.

The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism.

AIM: To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. METHODS: Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. RESULTS: The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. CONCLUSIONS: Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.