[Pulmonary and paradoxical embolism after total knee replacement--a case report].

Pneumatic tourniquet and hone cement are often applied in orthopaedic surgery. In lower limb surgery, deep vein thrombosis may occur after release of tourniquet, causing embolism of lungs and vital organs. Paradoxical embolism may develop if the patients present extracardiac or intracardiac right to left shunt, such as atrial septum defect, etc. A 60-year-old female patient suffered from osteoarthritis of both knees was admitted for total knee replacement (TKR). Pneumatic tourniquet was inflated on the operated leg for the orthopaedic surgery which lasted for 2h. Dyspnea, sinus tachycardia and abdominal pain were noted after TKR. Blood gases analysis showed arterial hypoxemia and respiratory alkalosis. Chest X-ray revealed diffused bilateral pulmonary infiltration, pulmonary trunk engorgement, and decreased lung markings. Two days after TKR under the impression of peritonitis, she received exploratory laparotomy in which ischemic bowel and gall bladder were found. Pulmonary and paradoxical embolism were diagnosed, both of which were the well-known complications of TKR with tourniquet and bone cement application. The patient finally succumbed because of multiple organ failures.