title: Fatal thromboembolism to the left pulmonary artery by locally applied hemostatic matrix after surgical removal of spinal schwannoma: a case report.
abstract: Locally applied hemostatic agents, mostly consisting of gelatinous granules with admixed human or bovine thrombin, are used in various surgical procedures. In our case, a 78-year-old woman underwent neurosurgical removal of an extraforaminal schwannoma of the L5 dorsal root ganglion. During the procedure, the hemostatic matrix consisting of a meshwork of bovine gelatinous granules admixed with human thrombin was locally applied to control diffuse paravertebral bleeding. Eight hours after surgery, the patient developed dyspnea with right heart failure and finally died. At autopsy, we found complete occlusion of the left pulmonary artery with a large thromboembolus. Histologically, that thromboembolus consisted of gelatinous granules with only a thin rim of surrounding, classic parietal thrombus. To our knowledge, this is the first description of fatal pulmonary embolization of a major lung artery with this material. The report depicts a possible life-threatening complication associated with the local application of hemostatic agents.
authors.affiliation: Institute of Pathology, Bundeswehrkrankenhaus Ulm, D-89081 Ulm, Germany. konrad@steinestel.com
authors.forename: Konrad
authors.initials: K
authors.lastname: Steinestel
authors.forename: Axel
authors.initials: A
authors.lastname: Geiger
authors.forename: Ramin
authors.initials: R
authors.lastname: Naraghi
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kunz
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Danz
authors.forename: Klaus
authors.initials: K
authors.lastname: Kraft
authors.forename: Gregor
authors.initials: G
authors.lastname: Freude
mesh_terms: D000368:Aged; D000818:Animals; D002417:Cattle; D017809:Fatal Outcome; D005260:Female; D005727:Ganglia, Spinal; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D008159:Lumbar Vertebrae; D008168:Lung / Q000473:pathology; D009442:Neurilemmoma / Q000150:complications / Q000601:surgery; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D011655:Pulmonary Embolism / Q000209:etiology*; D011859:Radiography; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000601:surgery; D013917:Thrombin / Q000009:adverse effects*
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics; D013917:Thrombin