The repeated demonstration by many workers that there is a high incidence of asymptomatic postoperative lower limb venous thrombosis suggests that pulmonary embolism is likely to be a more frequent occurrence than is commonly accepted. If this assumption is correct then many emboli must be asymptomatic or producing atypical symptoms.
The incidence of pulmonary artery perfusion defects in 50 general surgical patients who developed postoperative chest complications has been investigated by radioisotope scanning of the lungs. Nine of 10 patients considered on clinical grounds to have had a pulmonary embolus were shown on pulmonary scanning to have perfusion defects which would support such a diagnosis.
Of the 40 patients diagnosed as having postoperative chest infections, perfusion defects in the lung scan were present in 33. In 19 of these 33 the perfusion defect was associated with an inflammatory lesion or an abnormal position of the diaphragm, visible on the chest radiograph. However, in 7 of the 19 patients the size of the perfusion defect seemed disproportionately large when compared with the extent of the lesion visible on the chest radiograph.
In the remaining 14 patients the perfusion defects were not associated with any abnormality visible on the chest radiograph. It is considered that the perfusion defects in these 14 cases together with those in the seven cases in which the defect was disproportionately large represent `silent' pulmonary emboli.
It is suggested that pulmonary scanning carried out in cases of persistent postoperative chest infection will reveal, in many instances, a perfusion defect indicative of the presence of an underlying pulmonary embolus. In some cases this will be the precursor of a more major embolus.
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