Acute Massive Pulmonary Thromboembolism Occurring during Femur Surgery: The Key Role of Transesophageal Echocardiography : A case report

Kim, Hyun Jee; Kwak, Kyung Hwa; Jeon, Young Hoon; Kim, Si Oh

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2008;3(2):128-130.
Published online April 30, 2008.

Acute Massive Pulmonary Thromboembolism Occurring during Femur Surgery: The Key Role of Transesophageal Echocardiography : A case report

Hyun Jee Kim, Kyung Hwa Kwak, Young Hoon Jeon, Si Oh Kim

Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. hwakkh@hotmail.com

Abstract

We experienced a case, which showed the sudden drop of arterial oxygen saturation and capnographic score in a femur surgery patient under general anesthesia. We installed a transesophageal echocardiography probe in the patient and detected free-floating emboli in the right atrium, enlargement of the right atrium and the right ventricle, and global hypokinesia of the right ventricle. Because the patient's vital sign was so unstable, emergent cardiac and pulmonary embolectomy was performed with the use of cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged without any neurologic sequale. We concluded that transesophageal echocardiography was a useful device for the diagnosis of intraoperative massive pulmonary thromboembolism.

Key Words: general anesthesia, pulmonary thromboembolism, transesophageal echocardiography