Intraoperative pulmonary embolism during general anesthesia diagnosed with transesophageal echocardiography: A case report

Introduction: Acute pulmonary embolism (APE) is a potentially life-threatening condition with significant morbidity and mortality, particularly in the perioperative period. Early detection and intervention are crucial, but common signs and symptoms may not be easily identifiable under general anesthesia. This report presents a case of intraoperative APE in a 43-year-old female undergoing general anesthesia for left patella tendon repair following a ground-level fall. Case Report: During the procedure, the patient experienced an acute pulmonary embolism. Rescue transesophageal echocardiography (TEE) revealed a thrombus in the right main pulmonary artery and signs of right heart strain, including tricuspid regurgitation and right ventricular dilation. The patient was immediately taken to the interventional radiology suite for catheter thrombectomy. Following the procedure, her condition stabilized, and she was discharged with anticoagulation therapy. Conclusion: This case highlights the clinical challenges of diagnosing intraoperative APE in anesthetized patients, where typical symptoms may be obscured. Intraoperative TEE proved crucial in the timely detection of the embolism and enabled life-saving intervention. The importance of utilizing advanced diagnostic tools in managing intraoperative emergencies is underscored. Future research aimed at developing pathophysiologic models and diagnostic flowcharts for intraoperative APE may help improve outcomes in similarly challenging cases.