title: Ongoing paradoxical particulate embolism during megaprosthesis placement.
abstract: Pulmonary embolism (PE) by solid particles is an infrequent complication encountered during orthopedic procedures. A patent foramen ovale (PFO) allows embolic material into the left-sided circulation, potentially affecting several organs. A case of a 33-year-old woman undergoing total proximal femur resection with megaprosthesis reconstruction is presented. Towards the end of surgery, cement was injected to stabilize the prosthesis. Echodense particulate matter was first seen in the right atrium, subsequently in the right ventricle, and also in significant quantities in the left atrium and ventricle. This was accompanied by significant changes in partial pressure of arterial oxygen. Despite the aforementioned disturbances, hemodynamic stability was observed throughout the event. Postoperative follow-up showed persistent hypoxemia but no other abnormalities. This intriguing case of embolism via particulate material in a patient with PFO during hip replacement surgery allows review of the physiology and pathophysiology of PE phenomena.
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610-0254, USA. klaudanski@anest.ufl.edu
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Laudanski
authors.forename: Samir P
authors.initials: SP
authors.lastname: Patel
authors.forename: Yong G
authors.initials: YG
authors.lastname: Peng
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements / Q000009:adverse effects; D001859:Bone Neoplasms / Q000150:complications; D017548:Echocardiography, Transesophageal; D005260:Female; D005269:Femur / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006620:Hip Fractures / Q000209:etiology / Q000601:surgery; D006801:Humans; D010100:Oxygen / Q000097:blood; D052638:Particulate Matter / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D019919:Prosthesis Implantation / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy
chemical_list: D001843:Bone Cements; D052638:Particulate Matter; D010100:Oxygen