1999 Volume 21 Issue 3 Pages 318-322
We report an autopsy case of multiple paradoxical embolism after urological surgery. A 50 year-old woman who had a history of varicose veins of the leg lost consciousness and suffered dyspnea following bed rest for 20 hours after surgery. She was admitted to our hospital with coma, respiratory failure and hemiparesis on the left side. A pulmonary perfusion scan revealed multiple perfusion defects in the bilateral peripheral lung fields although a transthoracic echocardiogram lacked evidence of right atrium overload or intraluminal thrombus. A head CT scan on day 3 demonstrated large low density areas in the bilateral middle cerebral artery territories. She died on day 7 due to uncal herniation. An autopsy study disclosed a patent foramen ovale in the artial septum, large thrombus in the inferior vena cava, left pulmonary infarct, and massive and multiple brain infarct. This is a significant case of multiple paradoxical embolism following urological surgery confirmed by autopsy.
