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Imaging in an academic orthopedic shoulder service: a report on incidental lung pathology findings

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Abstract

Introduction

Computed tomography (CT) is often utilized for both diagnostic and pre-operative planning purposes in shoulder arthroplasty. Our study reports on the incidence of pulmonary findings in our pre-operative shoulder arthroplasty population over 14 years at our institution.

Methods

We conducted a retrospective review of all “shoulder CT” exams ordered by two orthopedic upper extremity surgeons between the years of 2008 and 2021. These exams were then further analyzed to include only those ordered for the purpose of pre-operative “shoulder arthroplasty” planning. All incidental findings were documented and those with pulmonary findings were then further analyzed. A detailed chart review was then performed on these patients to determine the impact on their planned shoulder arthroplasty.

Results

A total of 363 shoulder pre-operative CTs were ordered by our two upper extremity orthopedic surgeons at our institution between the years of 2008 and 2021. Primary lung cancer in the form of adenocarcinoma (n = 3) had an incidence of 0.8% of all CT scans and 1.4% of all pulmonary incidental findings. Fifteen patients (4% of all CT scans and 7% of all pulmonary incidental findings) had no concern for malignancy and were appropriately evaluated with further imaging based on their initial shoulder CT.

Conclusion

While shoulder arthroplasty and pre-operative planning with CT imaging continue to become more common, so too is the incidence of reported pulmonary findings. From a patient care standpoint, it is important that these findings are accurately identified, appropriately triaged, and communicated clearly to our patients.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of patient confidentiality but our general findings are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the University of Toronto.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, Ontario, M5T 1P5, Canada

    Lawrence Wengle, Christian Veillette & Timothy Leroux

  2. Joint Department of Medical Imaging (JDMI), Mount Sinai Hospital, University Health Network, Women’s College Hospital, ON, Toronto, Canada

    Lawrence M. White, Ali Naraghi & Mahsa Kamali

  3. Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, Erlangen, Germany

    Marcel Betsch

  4. The Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada

    Christian Veillette & Timothy Leroux

Authors
  1. Lawrence Wengle
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  2. Lawrence M. White
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  3. Ali Naraghi
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  4. Mahsa Kamali
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  5. Marcel Betsch
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  6. Christian Veillette
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  7. Timothy Leroux
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Correspondence to Lawrence Wengle.

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Wengle, L., White, L.M., Naraghi, A. et al. Imaging in an academic orthopedic shoulder service: a report on incidental lung pathology findings. Skeletal Radiol 53, 339–344 (2024). https://doi.org/10.1007/s00256-023-04406-4

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  • DOI: https://doi.org/10.1007/s00256-023-04406-4

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