Incidentally detected abnormal findings on contrast-enhanced computed tomography scan during thrombosis screening after hip surgery: a retrospective study

Background: Venous thromboembolism (VTE) is a potentially serious postoperative complication of hip surgery, including asymptomatic cases detectable by screening. During the study period, postoperative VTE screening was routinely performed using computed tomography pulmonary angiography (CTPA). CTPA is performed primarily to identify VTE, but other clinically significant abnormalities may be incidentally detected. The current study investigated the incidence of VTE after hip surgery as well as the frequency and characteristics of incidental abnormal findings identified on CTPA. Methods: This study included 753 patients who underwent CTPA one day after hip surgery. The presence of VTE and incidental findings was assessed by radiologists via CTPA. Incidental findings were classified into three categories—mild (observation only), moderate (requiring further evaluation), and severe (requiring urgent management)—and the nature of these findings was investigated. Results: In total, 34 (4.5%) and 83 (11.0%) patients presented with pulmonary embolism and deep vein thrombosis, respectively. Furthermore, 96 (12.7%) patients had incidentally detected abnormal findings, including clinically significant abnormalities; among them, 6 (0.8%) had malignant tumors or abnormalities requiring surgery. Conclusions: Postoperative CTPA can reveal incidental abnormalities beyond VTE detection. Radiologists should carefully evaluate CTPA images for incidental findings and ensure appropriate clinical follow-up when necessary. Timely recognition and management of incidental findings may improve patient care. Therefore, clinicians should be vigilant to unexpected radiological findings, and a system that can facilitate proper recognition and subsequent action for such findings must be developed.