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A 53-year-old woman with no significant medical history presented with 10/10 right buttock pain that radiated to the right groin. With no reported recent injury, the absence of fever, and no identifiable risk factors, an infectious etiology, including septic sacroiliitis (SSI), is at the end spectrum of the differential. SSI is a rare condition with nonspecific findings that can lead to major complications, including death. To our knowledge, there are only 4 recent major literature reviews on SSI, with most cases reported to have at least 1 risk factor or clinical sign indicating the possibility of an infectious etiology. The patient reported in this case had no identifiable risk factors; therefore, high clinical suspicion is needed to prevent debilitating consequences from prolonged infection. LEVEL OF EVIDENCE: V. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is a potentially fatal complication of total joint arthroplasty. Therefore, it is essential to have reliable means for diagnosis and evaluation of severity. In the study reported here, we evaluated the reliability of common clinical signs and symptoms in the diagnosis of PE. In addition, we used correlation analysis to assess for a correlation between clinical presentation and size and location of the embolus within the pulmonary vasculature. Included in this study were 13,133 patients who underwent total joint arthroplasty between 2000 and 2005. PE was diagnosed in 144 patients (1.1%). Shortness of breath (31.9%) and hypotension (30.6%) were the most frequent symptom and sign. Oxygen desaturation was the only indication for investigation of PE in 10% of patients. A pulse-oximetry reading of less than 90% was present in 63% of patients, and 92% of patients presented with an increased alveolar-arterial gradient. Overall, clinical signs and symptoms as well as severity of hypoxia did not correlate with size and location of PE. Patients with PE demonstrated a significant decrease in arterial oxygen content; an abnormal alveolar-arterial gradient was the most consistent finding in these patients. Common clinical signs and symptoms, as well as changes in vital signs, have a low sensitivity for diagnosis.