Early one-lung ventilation with capnography unmasked an asymptomatic left-sided pulmonary embolism by revealing a widened arterial-to-end-tidal CO2 gradient (36 mmHg vs 7.1 mmHg).
Case Report (n=1)
Early one-lung ventilation with capnography can serve as a crucial intraoperative diagnostic tool to unmask asymptomatic unilateral pulmonary embolism, guiding surgical management.
A minimally invasive thoracoscopic approach for right atrial masses is contraindicated in the presence of concomitant pulmonary embolism (PE), as pulmonary embolectomy would be required but cannot be performed through a thoracoscopic incision. A 48-year-old woman on hemodialysis was scheduled for thoracoscopic excision of a right atrial mass. Post-induction, left-sided one-lung ventilation (OLV) precipitated hypoxemia and a sharp drop in end-tidal CO 2 , in contrast to normal findings during right-sided OLV. A widened arterial-to-end-tidal CO 2 gradient (36 mmHg during left sided OLV vs. 7.1 mmHg during right sided OLV) confirmed left-sided PE, prompting conversion to sternotomy for successful mass and emboli removal. This case highlights that asymptomatic PE can be missed preoperatively. Early OLV with capnography is a crucial intraoperative diagnostic tool for unilateral PE, guiding surgical management in high risk patients. For bilateral PE, this technique may not show a side to side difference.
Chen et al. (Thu,) conducted a case report in Right atrial mass and asymptomatic pulmonary embolism (n=1). Early one-lung ventilation with capnography was evaluated on Detection of unilateral pulmonary embolism. Early one-lung ventilation with capnography unmasked an asymptomatic left-sided pulmonary embolism by revealing a widened arterial-to-end-tidal CO2 gradient (36 mmHg vs 7.1 mmHg).