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Pulmonary embolism (PE) remains a common preventable cause of death in hospitalized patients. The purpose of this study is to examine the in-hospital management, complications of treatment and clinical outcomes of inpatients undergoing lung scintigraphy for the diagnosis of PE in a regional hospital. Two hundred consecutive inpatients with suspected PE were enrolled. The results of lung scans, stratified according to the probability of pulmonary embolism, were correlated with anticoagulation status, discharge diagnosis, haemorrhagic complications and clinical outcome at 6 months. The use of complementary imaging investigations was also determined. Other imaging was performed infrequently (Doppler ultrasound in 18% of patients, CT pulmonary angiography (CT-PA) in 0.5% and conventional pulmonary angiography in 4% of patients). Long-term anticoagulation was initiated in 66 patients (33%), including 10 with intermediate probability lung scans (IPLS) who had no further investigations. Major haemorrhage occurred in 14% of all long-term anticoagulated patients followed up. The recognized recurrence rate was very low (3%) and there was no documented mortality from PE. Most patients with suspected PE are treated on the basis of the lung scan result without further tests. However, other imaging (especially CT-PA and conventional pulmonary angiography) should be performed prior to anticoagulation in patients with IPLS in whom the diagnosis is in doubt. Standard anticoagulation for 6 months appears to be effective for PE, and the recurrence rate is low. However, it has a significant risk of major haemorrhagic complications.

SUMMARY Primary breast carcinomas are generally thallium (Tl-201) avid but uncommonly accumulate gallium (GA-67). Therefore, GA-67 scans are not routinely performed in patients with suspected breast cancer. We report a rare case of a primary breast carcinoma with bone marrow metastases where the primary lesion was GA-67 avid but did not accumulate Tl-201. The case also illustrated an unusual presentation of aggressive metastatic breast adenocarcinoma with pancytopenia or bone marrow failure. The extensive bone marrow metastases of the primary breast carcinoma were evident on both the Tl-201 and GA-67 scans.