SHM Converge Scientific Abstract ePoster Gallery-Pulmonary Artery Air Embolism Status Post Right Hip Total Arthroplasty

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This case report describes a rare but potentially fatal complication: pulmonary artery air embolism after right total hip arthroplasty. An 83-year-old woman with COPD, coronary artery disease s/p CABG, hypertension, hyperlipidemia, and heavy smoking history became severely hypoxic in the post-anesthesia care unit after an otherwise uncomplicated revision hip arthroplasty. She denied chest pain or dyspnea but developed acute hypoxic respiratory failure despite supplemental oxygen and BiPAP. Chest x-ray showed only left basilar atelectasis, and the initial CT pulmonary embolism study was read as negative for PE. However, on visual review, an air embolus was identified in the main pulmonary artery.<br /><br />Management included 100% oxygen, left lateral decubitus positioning, and supportive respiratory care. The patient improved from BiPAP to high-flow nasal cannula, then nasal cannula, and eventually room air. Her ICU stay was later complicated by Clostridium difficile colitis, which was treated with oral vancomycin. She was ultimately transferred out of the ICU and discharged home in stable condition.<br /><br />The discussion highlights that air embolism can occur during total hip arthroplasty, especially cemented procedures, due to increased intramedullary pressure forcing air and other material into the venous circulation. Symptoms may include hypoxia, dyspnea, chest pain, hypotension, and shock. Prompt imaging and recognition are essential. Treatment is primarily supportive and includes 100% oxygen, positioning to reduce further embolization, and in severe cases, vasopressors, volume support, or hyperbaric therapy.<br /><br />Overall, the report emphasizes the importance of recognizing pulmonary artery air embolism early, even when initial imaging interpretation is negative.

Asset Subtitle

Sara Hassan

Meta Tag

Author List Natalie Millet, Sara Hassan

Category Clinical Vignettes

Concept Pulmonary Artery Air Embolism

Concept Arthroplasty

Concept Hypoxia

Concept Oxygen

Concept Cemented Arthroplasty

Distinguished Non-Finalist

Presenter Organization Ocean University Medical Center

Presenting Author Sara Hassan

Track Adult

Keywords

pulmonary artery air embolism

total hip arthroplasty

hypoxic respiratory failure

post-anesthesia care unit

computed tomography pulmonary embolism

100% oxygen therapy

left lateral decubitus positioning

cemented hip arthroplasty

Clostridium difficile colitis

hyperbaric therapy

Pulmonary Artery Air Embolism

Arthroplasty

Hypoxia

Oxygen

Cemented Arthroplasty