title: Paradoxical carbon dioxide embolism during endoscopic thyroidectomy confirmed by transesophageal echocardiography.
abstract: Carbon dioxide (CO₂) embolism is a rare but potentially life-threatening complication of laparoscopic procedures. Although endoscopic thyroidectomy using CO₂ gas insufflation appears to be superior to conventional open thyroidectomy in terms of cosmetic results, it may cause venous or fatal paradoxical CO₂ embolism. We report a case of paradoxical CO₂ embolism during CO₂ gas insufflation in an endoscopic thyroidectomy that was confirmed by transesophageal echocardiography (TEE). Paradoxical embolization via transpulmonary right-to-left shunting of venous CO₂ gas emboli was revealed by TEE examination. The patient recovered without complications. In conclusion, although endoscopic thyroidectomy is a promising approach that is gaining popularity and offers excellent cosmetic results compared with conventional open thyroidectomy, this case report emphasizes the importance of anticipating and being vigilant for potential CO₂ embolism.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, 1 Hwayang-Dong, Gwanggin-Gu, Seoul 143-701, South Korea.
authors.forename: Seong-Hyop
authors.initials: SH
authors.lastname: Kim
authors.forename: Kyoung-Sik
authors.initials: KS
authors.lastname: Park
authors.forename: Hwa-Yong
authors.initials: HY
authors.lastname: Shin
authors.forename: Jun-Hee
authors.initials: JH
authors.lastname: Yi
authors.forename: Duk-Kyung
authors.initials: DK
authors.lastname: Kim
mesh_terms: D002245:Carbon Dioxide; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000000981:diagnostic imaging* / Q000209:etiology; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging* / Q000209:etiology; D004724:Endoscopy; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007327:Insufflation; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging; D013965:Thyroidectomy
chemical_list: D002245:Carbon Dioxide