Background and aims Compact ultrasound devices are ubiquitous in modern operating rooms. We report a case of pulmonary embolism, which was diagnosed with point-of-care ultrasonography (POCUS) in a patient immediately after surgery for an ankle fracture.

Methods An 84 year-old-woman underwent a non-scheduled surgery because of an ankle fracture. She fell in the bathroom, hit her head and fractured her right ankle. She was only transiently unconscious. She had upper arm surgery 8 days earlier and she had mild dyspnea, fever, diaphoresis, and tachycardia since this event of fall. The surgery was performed under general anesthesia combined with the femoral triangle block and sciatic nerve block. The surgery took 1 hour. Her anesthesia course was unstable. Her heart rate varied between 95 and 140 bpm and systolic blood pressure varied between 70 and 110 mmHg. Her SpO₂ was 92–98%, though F_IO₂ was maintained at 50%. Because of the unstable hemodynamic state and unexplained low SpO₂, we performed POCUS to rule out disorders in the heart and lung.

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Abstract ESRA19-0067 Figure 1

Filling defects in the right and left pulmonary arteries are shown in the CT angiography (Chest CT coronal view)

Results It revealed a dilated right ventricle (RV) with reduced free wall motion of the RV and a moderate tricuspid regurgitant (TR) jet with the peak TR pressure gradient 41 mmHg. Further, we confirmed a D-shaped left ventricle during diastole in the short axis view. Subsequent CT demonstrated filling-defects in the right and left pulmonary arteries.

Conclusions This case provides two lessons that PE could manifest as a fall in postoperative patients and that POCUS plays a pivotal role in the diagnosis of PE in the operating room.