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Background: The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. Methods: Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging. Results: Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%, P P Conclusions: In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.

Resumen Introduccion La rotura de los ligamentos cruzados de la rodilla es frecuente y se repara mediante ligamentoplastia artroscopica. Entre sus complicaciones esta la artritis septica. El objetivo de este trabajo es describir las caracteristicas clinicas y microbiologicas de esta entidad. Metodos Revision retrospectiva de casos de artritis septica tras ligamentoplastia de rodilla ocurridos en una institucion durante los anos 2000-2015. Segun los dias transcurridos desde la ligamentoplastia, la infeccion se considero aguda ( 14 dias y 30 dias). Se realizo un analisis descriptivo y comparativo, estratificado segun el tipo de infeccion y microorganismo causante. Resultados Se intervinieron 3.219 pacientes; 30 (0,9%) desarrollaron artritis septica. Diecisiete (57%) infecciones fueron agudas, 12 (40%) subagudas y una tardia. Los microorganismos causantes fueron Staphylococcus coagulasa-negativos (n = 13; 43%), Staphylococcus aureus (n = 12; 40%), otros cocos grampositivos (n = 3; 10%) y bacilos gramnegativos (n = 2; 7%). Se realizo desbridamiento artroscopico en todos los casos; en ninguno fue necesario retirar la plastia. Los pacientes recibieron tratamiento antibiotico durante una mediana de 23,5 dias (rango, 14 - 78 dias); todas las infecciones se curaron. No se evidenciaron diferencias significativas en ninguna de las variables analizadas entre el tipo de infeccion o el microorganismo responsable. Conclusiones La artritis septica es una complicacion poco frecuente de la ligamentoplastia de rodilla. Se manifiesta generalmente dentro de las 4 semanas despues de la cirugia y esta causada por Staphylococcus . El tratamiento consiste en desbridamiento artroscopico precoz (pudiendo no ser necesario retirar la plastia) y antibioterapia.

Introduction Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. Methods Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000 to 2015. According to time elapsed from surgery, infections were classified as acute ( 14 days and 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. Results 3219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n = 13; 43%), Staphylococcus aureus (n = 12; 40%), other Gram positive cocci (n = 3; 10%), and Gram negative bacilli (n = 2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14–78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. Conclusions Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy.