Massive Intraoperative Pulmonary Embolism: It may not be as Bad as it Looks …

Abstract

An elderly patient suffered a cardiac arrest while undergoing repair of a pathological femoral fracture. Intraoperative transoesophageal echocardiography demonstrated massive pulmonary embolism. Pulmonary embolectomy was considered inappropriate in view of her underlying terminal disease, so a decision was made to withdraw all further supportive measures. Despite this, the patient's haemodynamics improved spontaneously.The embolic material was presumed to be bone marrow fat. Fat may traverse the pulmonary circulation; hence the clinical consequences (and management implications) of massive intraoperative pulmonary embolism may vary, depending on the composition of the embolic material. As there are no reliable means of determining the composition of embolic material intraoperatively, the clinical suspicion of fat embolism poses a management dilemma. Should these cases be managed surgically or conservatively?

The Implications of Pulmonary Embolism in a Multiorgan Donor for Subsequent Pulmonary, Renal, and Cardiac Transplantation

“…6 For example, the effect of fat emboli on the lung is described as biphasic: (1) an immediate effect due to mechanical obstruction of pulmonary capillaries (e.g., simple fat embolism) and (2) toxic and biochemical effects associated with a subsequent systemic inflammatory response syndrome (e.g., fat embolism syndrome). 7,8 Fat embolism can be demonstrated by single organ involvement, such as acute respiratory failure, whereas fat embolism syndrome has a wider effect leading to multiple organ failure.…”