Fatal thromboembolism to the left pulmonary artery by locally applied hemostatic matrix after surgical removal of spinal schwannoma: a case report

SummaryLocally applied hemostatic agents, mostly consisting of gelatinous granules with admixed human or bovine thrombin, are used in various surgical procedures. In our case, a 78-year-old woman underwent neurosurgical removal of an extraforaminal schwannoma of the L5 dorsal root ganglion. During the procedure, the hemostatic matrix consisting of a meshwork of bovine gelatinous granules admixed with human thrombin was locally applied to control diffuse paravertebral bleeding. Eight hours after surgery, the patient developed dyspnea with right heart failure and finally died. At autopsy, we found complete occlusion of the left pulmonary artery with a large thromboembolus. Histologically, that thromboembolus consisted of gelatinous granules with only a thin rim of surrounding, classic parietal thrombus. To our knowledge, this is the first description of fatal pulmonary embolization of a major lung artery with this material. The report depicts a possible life-threatening complication associated with the local application of hemostatic agents.