Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study

Author:

Dittrich Tolga D12ORCID,Aujesky Mara12,Rudin Salome12,Zietz Annaelle12,Wagner Benjamin12ORCID,Polymeris Alexandros12ORCID,Altersberger Valerian L12,Sinnecker Tim12,Gensicke Henrik123,Engelter Stefan T123,Lyrer Philippe12,Hess Viviane24,Sutter Raoul25,Nickel Christian H26,Bonati Leo H127,Fischer Urs12,Psychogios Marios28,Katan Mira12,De Marchis Gian Marco12ORCID

Affiliation:

1. Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland

2. Department of Clinical Research, University of Basel, Basel, Switzerland

3. Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland

4. Department of Oncology, University Hospital Basel and University of Basel, Basel, Switzerland

5. Department of Intensive Care Medicine, University Hospital and University of Basel, Basel, Switzerland

6. Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland

7. Rehabilitation Clinic, Rheinfelden, Switzerland

8. Department of Neuroradiology, University Hospital and University of Basel, Basel, Switzerland

Abstract

Background: Computed tomography angiography (CTA) of the supraaortic arteries is commonly used for acute stroke workup and may reveal apical pulmonary lesions (APL). Aim: To determine the prevalence, follow-up algorithms, and in-hospital outcomes of stroke patients with APL on CTA. Methods: We retrospectively included consecutive adult patients with ischemic stroke, transient ischemic attack, or intracerebral hemorrhage and available CTA at a tertiary hospital between January 2014 and May 2021. We reviewed all CTA reports for the presence of APL. APL were classified as malignancy suspicious or benign appearing based on radiological-morphological criteria. We performed regression analyses to investigate the impact of malignancy suspicious APL on different in-hospital outcome parameters. Results: Among 2715 patients, APL on CTA were found in 161 patients (5.9% [95%CI: 5.1–6.9]; 161/2715). Suspicion of malignancy was present in one third of patients with APL (36.0% [95%CI: 29.0–43.7]; 58/161), 42 of whom (72.4% [95%CI: 60.0–82.2]; 42/58) had no history of lung cancer or metastases. When performed, further investigations confirmed primary or secondary pulmonary malignancy in three-quarters (75.0% [95%CI: 50.5–89.8]; 12/16), with two patients (16.7% [95%CI: 4.7–44.8]; 2/12) receiving de novo oncologic therapy. In multivariable regression, the presence of radiologically malignancy suspicious APL was associated with higher NIHSS scores at 24 h (beta = 0.67, 95%CI: 0.28–1.06, p = 0.001) and all-cause in-hospital mortality (aOR = 3.83, 95%CI: 1.29–9.94, p = 0.01). Conclusions: One in seventeen patients shows APL on CTA, of which one-third is malignancy suspicious. Further work-up confirmed pulmonary malignancy in a substantial number of patients triggering potentially life-saving oncologic therapy.

Funder

Universitätsspital Basel

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

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