Intractable intraoperative hypoxemia secondary to pulmonary embolism in the presence of undiagnosed patent foramen ovale

The management of a patient with hip fracture during general anesthesia, who developed severe intractable hypoxemia caused by intraoperative pulmonary embolism in the presence of undiagnosed patent foramen ovale, is described. The role of urgent intraoperative transesophageal echocardiography in situations where acute perioperative pulmonary embolism/patent foramen ovale is suspected is emphasized.