Fatal bone marrow embolism following thoracotomy

Abstract

A case of congenital heart disease in an adult is presented in which exploratory thoracotomy with sternal transection was carried out. Two days postoperatively, the patient became unduly anxious and somewhat dyspneic. Four days postoperatively, the patient suddenly became extremely dyspneic, apprehensive and cyanotic and went into cardiac arrest five minutes later. Successful cardiac massage was carried out, but the patient died several hours later with the cause of her death unexplained at the time. Bone marrow in relatively large amount was found in the branches of the pulmonary arterial supply, and either this per se, or embolization of the heart or brain via a patent septal defect is regarded as the cause of death. A summary of the clinical and pathologic features, as well as the laboratory aids in the diagnosis is presented to focus on a possible cause of complication and death following thoracotomy of this type.