Journal of Anesthesia

, Volume 24, Issue 5, pp 774–777 | Cite as

Paradoxical carbon dioxide embolism during endoscopic thyroidectomy confirmed by transesophageal echocardiography

  • Seong-Hyop Kim
  • Kyoung-Sik Park
  • Hwa-Yong Shin
  • Jun-Hee Yi
  • Duk-Kyung Kim
Clinical Report


Carbon dioxide (CO2) embolism is a rare but potentially life-threatening complication of laparoscopic procedures. Although endoscopic thyroidectomy using CO2 gas insufflation appears to be superior to conventional open thyroidectomy in terms of cosmetic results, it may cause venous or fatal paradoxical CO2 embolism. We report a case of paradoxical CO2 embolism during CO2 gas insufflation in an endoscopic thyroidectomy that was confirmed by transesophageal echocardiography (TEE). Paradoxical embolization via transpulmonary right-to-left shunting of venous CO2 gas emboli was revealed by TEE examination. The patient recovered without complications. In conclusion, although endoscopic thyroidectomy is a promising approach that is gaining popularity and offers excellent cosmetic results compared with conventional open thyroidectomy, this case report emphasizes the importance of anticipating and being vigilant for potential CO2 embolism.


Embolism Paradoxical Endoscopy Pulmonary embolism Thyroidectomy 


Conflict of interest

The authors have no conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2010

Authors and Affiliations

  • Seong-Hyop Kim
    • 1
  • Kyoung-Sik Park
    • 2
  • Hwa-Yong Shin
    • 1
  • Jun-Hee Yi
    • 1
  • Duk-Kyung Kim
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineKonkuk University School of MedicineSeoulSouth Korea
  2. 2.Department of SurgeryKonkuk University School of MedicineSeoulSouth Korea

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