Intraoperative Pulmonary Embolism During General Anesthesia Diagnosed with Transesophageal Echocardiography: A Case Report

Abstract Acute pulmonary embolism (APE) can be a life-threatening event with significant morbidity and mortality, particularly in the perioperative period. While early detection and intervention are essential, the common signs and symptoms are not overtly detectable under general anesthesia. Here, we present a case of an otherwise healthy 43-year-old female who presented with an intraoperative pulmonary embolism during general anesthesia for left patella tendon repair following a ground-level fall. 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 emergently taken to the interventional radiology suite and treated with catheter thrombectomy. The patient’s condition stabilized post-procedure, and she was subsequently discharged with anticoagulation therapy. The current case study elucidates the clinical challenges of diagnosing intraoperative APE, particularly in anesthetized patients where typical symptoms are masked. Intraoperative TEE played a pivotal role in early embolism detection and facilitated prompt, life-saving intervention. This case recapitulates the vital importance of utilizing advanced diagnostic tools in managing intraoperative emergencies. Future studies on developing pathophysiologic models and flowcharts specifically for intraoperative APE could significantly reduce adverse outcomes in diagnostically challenging cases.