Pulmonary thrombotic arteriopathy (PTA) can be an incidental finding in lung resections performed for various indications. Historic studies largely examined PTA in autopsies. Thus, the prevalence in surgical samples, particularly in the modern era of lung cancer screening, is poorly defined. Detection of PTA in surgical samples may provide an opportunity for therapeutic intervention, but the impact of this finding on clinical management is unknown. We retrospectively examined consecutive lung surgical resections containing a report of incidental PTA between 2019 and 2022 in our institution. A retrospective chart review was performed to determine the history of systemic thromboembolism and clinical and radiographic follow-up. All slides were reviewed to morphologically characterize the vascular changes. Among 2930 pulmonary resections, 66 (2.3%) reportedly contained PTA. Twenty-four (36.4%) patients had a clinically recognized thromboembolic event either before or after surgical resection. Patients with clinically recognized thromboembolic disease were significantly more likely to have both acute and organized thrombi affecting large arteries. The presence of infarct, chronic hypertensive vasculopathy, or number of vessels with thrombi were not significantly associated with a clinically detected event. Reporting of incidental PTA led to clinical intervention in six patients and confirmed systemic thromboembolic disease in 2. Moreover, 2 patients with no further workup based on the incidental pathology findings subsequently developed pulmonary embolism. PTA is incidentally detected in 2.3% of surgical lung resections, and in two-thirds of cases, there is no clinical suspicion of thromboembolic disease. Pathologic reporting of PTA rarely led to clinical intervention, suggesting a need for improved communication of incidental pathology findings.

中文翻译：

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肺切除标本中偶发血栓性动脉病的报告：临床影响检查。


肺血栓性动脉病 （PTA） 可能是针对各种适应症进行肺切除术的偶然发现。历史研究主要检查了尸检中的 PTA。因此，手术样本中的患病率，尤其是在现代肺癌筛查中，定义不明确。在手术样本中检测到 PTA 可能为治疗干预提供机会，但这一发现对临床管理的影响尚不清楚。我们回顾性检查了 2019 年至 2022 年间在我们机构包含偶然 PTA 报告的连续肺部手术切除。进行回顾性图表回顾，以确定全身性血栓栓塞病史以及临床和影像学随访。回顾所有载玻片以从形态学上表征血管变化。在 2930 例肺切除术中，据报道 66 例 （2.3%） 含有 PTA。24 例 （36.4%） 患者在手术切除前后有临床认可的血栓栓塞事件。临床认可的血栓栓塞性疾病患者明显更有可能同时出现影响大动脉的急性血栓和组织性血栓。梗死、慢性高血压血管病变或血栓血管数量与临床检测事件无显著相关性。偶然 PTA 的报告导致 6 例患者进行临床干预，2 例患者确诊全身性血栓栓塞性疾病。此外，2 例根据偶然的病理发现没有进一步检查的患者随后发展为肺栓塞。在 2.3% 的外科肺切除术中偶然检测到 PTA，在 2/3 的病例中，临床上没有怀疑血栓栓塞性疾病。 PTA 的病理报告很少导致临床干预，这表明需要改进偶然病理结果的交流。