Visceral Malignancy is a Risk Factor for Pulmonary Embolism
Among the options listed, visceral malignancy is the established risk factor for developing pulmonary embolism. Cancer is well-recognized as a predisposing factor for venous thromboembolism (VTE), with the risk varying by cancer type—pancreatic cancer, hematological malignancies, lung cancer, gastric cancer, and brain cancer carry the highest risk 1. Moreover, cancer is a strong risk factor for all-cause mortality following a VTE episode 1.
Analysis of Each Option
Visceral Malignancy (CORRECT ANSWER)
The 2019 ESC Guidelines explicitly state that cancer is a well-recognized predisposing factor for VTE 1. The association between VTE and overt cancer is well-documented, with patients presenting with so-called idiopathic PE developing subsequent malignant neoplasms in approximately 10% of cases 2. The risk is particularly elevated with visceral malignancies affecting internal organs.
Chronic Glucocorticoid Use (INCORRECT - but noteworthy)
While chronic glucocorticoid use is not mentioned in the major ESC guidelines as an established PE risk factor 1, recent research evidence suggests an association. Studies show patients treated with oral glucocorticoids may have increased PE risk, especially during the first month of exposure 3. However, this represents emerging research data rather than guideline-established risk factors, and the effect may be confounded by the underlying inflammatory conditions requiring steroid treatment 4.
Presence of an IUD (INCORRECT)
The 2019 ESC Guidelines specifically clarify that hormone-releasing intrauterine devices are NOT associated with a significant increase in VTE risk 1. This distinguishes IUDs from combined oral contraceptives (containing both estrogen and progestogen), which do carry a two- to six-fold increased VTE risk 1. Following counseling and risk assessment, IUDs are often proposed to women with personal or strong family history of VTE precisely because they lack this thrombotic risk 1.
Anorexia (INCORRECT)
Anorexia is not identified as a risk factor for PE in any of the provided guidelines. The established risk factors focus on hypercoagulable states, immobilization, malignancy, hormonal factors, surgery/trauma, and inflammatory conditions 1.
Clinical Implications
When evaluating PE risk, prioritize assessment for:
- Active malignancy (especially pancreatic, hematological, lung, gastric, brain)
- Recent surgery, trauma, or immobilization
- Combined oral contraceptive use (but not IUD use)
- Infection or inflammatory conditions
- Prior VTE history
The presence of malignancy not only increases PE risk but also significantly worsens prognosis following a VTE event, making early recognition and appropriate anticoagulation critical 1.