title: Pulmonary embolism after hip or knee replacement: postoperative changes on pulmonary scintigrams in asymptomatic patients.
abstract: Serial pulmonary imaging has proved to be effective in the evaluation of patients undergoing total joint arthroplasty. A clinical dilemma arises in asymptomatic patients whose postoperative pulmonary images differ from the preoperative images. The authors prospectively evaluated 403 patients with serial imaging to determine the significance of changed postoperative images in asymptomatic patients undergoing total hip or knee arthroplasty. Twenty-two (5.5%) patients had significant changes on postoperative images. Seventeen were asymptomatic; all but one underwent pulmonary angiography. Documented pulmonary emboli were demonstrated in 100% of patients whose postoperative images changed to indicate a high probability of pulmonary embolism, 71% whose images changed to a moderate probability, and 0% whose images changed to indeterminate probability. Overall, pulmonary emboli occurred in 76% of all asymptomatic patients with significantly change postoperative images. Asymptomatic pulmonary embolism is a significant occurrence after total hip or knee repair, and a changed lung scan with appropriate clinical evaluation is an accurate indicator of pulmonary emboli in asymptomatic postarthroplasty patients.
authors.affiliation: Department of Radiology, Pennsylvania Hospital, Philadelphia 19107.
authors.forename: M
authors.initials: M
authors.lastname: Foley
authors.forename: M M
authors.initials: MM
authors.lastname: Maslack
authors.forename: R H
authors.initials: RH
authors.lastname: Rothman
authors.forename: M P
authors.initials: MP
authors.lastname: Casey
authors.forename: E M
authors.initials: EM
authors.lastname: Lugano
authors.forename: C E
authors.initials: CE
authors.lastname: Parry
authors.forename: R A
authors.initials: RA
authors.lastname: Balderston
authors.forename: R E
authors.initials: RE
authors.lastname: Booth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D011859:Radiography; D011877:Radionuclide Imaging