title: Novel imaging strategy for the detection of fat embolism after arthroplasty.
abstract: BACKGROUND
  Respiratory complications are common after arthroplasty with fat emboli and thromboembolic disease (PTE) being the most serious. As fat embolism from bone marrow should contain reticuloendothelial cells, we hypothesized that these cells take up colloid in the lung. A prospective tomographic study of 99m Tc phytate and perfusion was performed within 24 h after arthroplasty.
  
  
  METHODS
  Tomographic lung studies were acquired after 99m Tc phytate and 99m Tc MAA injection. Pre- and postoperative arterial blood gases (ABG), radiography/computed tomography were obtained. ABG were analysed as the difference in alveolar-arterial oxygen gradients, pre- and postoperatively (D(A-a)).
  
  
  RESULTS
  Forty patients were studied, 16 with hip and 24 with knee arthroplasties. Lung uptake of 99m Tc phytate was present in 35% of cases. PTE was detected in 25 of 38 (67%) patients evaluated. D(A-a) was significantly different between patients with PTE/fat embolism and without either entity (P < 0.05).
  
  
  CONCLUSIONS
  A simple test is available for the detection of fat embolism in the lungs. It can specifically differentiate this common cause of hypoxia from PTE.
authors.affiliation: Department of Orthopaedic Surgery, Concord Hospital, Sydney, New South Wales, Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Bruce
authors.forename: Hans
authors.initials: H
authors.lastname: Van der Wall
authors.forename: Matthew
authors.initials: M
authors.lastname: Peters
authors.forename: Lucy
authors.initials: L
authors.lastname: Morgan
authors.forename: Yong
authors.initials: Y
authors.lastname: Hian Liaw
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Storey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000009:adverse effects*; D004620:Embolism, Fat / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010833:Phytic Acid; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C026177:technetium phytate; D010833:Phytic Acid