Fat embolism syndrome (FES) is a known complication of long-bone fractures, typically occurring 24-48 h post-trauma and characterized by petechial rash, neurological symptoms, and pulmonary distress. Cerebral fat embolism (CFE), which can be fatal, can result from brain emboli. We report a case of a 17-year-old male who sustained bilateral closed femur fractures in a road traffic accident. The patient presented with immediate neurological distress, including coma, without respiratory symptoms. The brain's CT scan was normal initially. Still, an MRI later showed signs of FES, such as T2 and diffusion hyperintensities on the corpus callosum, a lipid peak on spectroscopy, and a microbleed. Delayed awakening and status epilepticus, treated with anticonvulsants, complicated the patient's course. This case highlights the diagnostic utility of MRI in detecting CFE. It emphasizes the need to consider FES in isolated neurological symptoms following long-bone fractures, even without respiratory distress. Early surgical fixation of fractures remains critical for prevention.

Liposuction is a very common plastic surgery procedure. Post-liposuction complications are uncommon but can be life-threatening, and early cardio-pulmonary symptoms may mimic benign postoperative responses. Serious complications such as fat embolism syndrome (FES) and pulmonary embolism rarely present within the first few hours, and an atypically early onset can create significant diagnostic uncertainty. FES, in particular, may initially manifest with subtle or nonspecific symptoms, contributing to missed or delayed recognition. We report the case of a 34-year-old previously healthy woman who presented to the emergency department with palpitations, dizziness, and hypotension approximately one hour after undergoing cosmetic liposuction under local anesthesia. Her presentation was atypical both in timing and in the absence of the classic triad of respiratory distress, neurological changes, and petechial rash. Given the unusually early onset, FES was considered but required careful differentiation from other postoperative causes of acute cardiopulmonary symptoms.

Objective: To investigate the clinical features, diagnostic approaches, and treatment strategies of primary pulmonary artery large cell neuroendocrine carcinoma (LCNEC), and to improve clinicians' awareness of this rare disease. Methods: A retrospective analysis was conducted on the clinical data of a patient with primary pulmonary artery LCNEC, who initially presented with anticoagulation-refractory "pulmonary embolism." A systematic literature review was also performed by searching domestic and international databases to summarize the clinical presentations, pathological characteristics, molecular markers, and therapeutic advances of this disease. Results: The patient was a 59-year-old male diagnosed with pulmonary artery LCNEC after pulmonary endarterectomy. Molecular pathological analysis identified a compound NRAS exon 3 mutation. The patient subsequently received etoposide plus cisplatin (EP), irinotecan, and third-line combination therapy of serplulimab, anlotinib, and temozolomide. At the last follow-up, overall survival exceeded 33 months. The literature review identified only one similar reported case, highlighting the extreme rarity of this disease. Conclusions: Primary pulmonary artery LCNEC lacks specific clinical manifestations and is easily misdiagnosed as pulmonary embolism or pulmonary artery sarcoma. Radical surgery combined with platinum-based chemotherapy constitutes the mainstay of treatment. Molecular testing can provide a basis for personalized therapy, and multiline comprehensive treatment may offer prolonged survival benefits for patients.

A man in his 20s underwent wound debridement and external fixation for a femoral fracture sustained in a blast injury. Anaesthesia was induced with propofol and nalbuphine and the airway was secured with an i-gel laryngeal mask. About 45 min after induction, irrigation of the semiclosed wound with hydrogen peroxide was followed by a sudden fall in end-tidal carbon dioxide and tachycardia, which progressed rapidly to asystole. Cardiopulmonary resuscitation was started immediately, and tracheal intubation was performed during the first cycle of compressions. Return of spontaneous circulation occurred 6 min later. The patient recovered fully with no neurological or cardiovascular sequelae. The close temporal link between hydrogen peroxide irrigation and circulatory collapse was suggestive of intraoperative oxygen embolism, likely facilitated by oxygen liberation in a confined cavity. This case highlights the need to limit or avoid the use of hydrogen peroxide as irrigant whenever possible, and exercise caution and preparedness whenever its use becomes unavoidable.

Pulmonary embolism (PE) is one of the leading causes of cardiovascular mortality in the United States. Even in those patients who get treatment in the acute phase, they are at risk of developing pulmonary hypertension, recurrent PE, which can lead to functional impairment and decreased survival. Interventional therapies for PE are reserved for unstable patients with high-risk PE or stable patients at high risk for decompensation. Several large-bore devices are currently approved for the treatment of PE and can provide expeditious thrombus removal without the need for lytic agents. Here, we review some of the large-bore catheter devices available for the treatment of acute PE.

Acute pulmonary embolism (PE) remains a leading cause of cardiovascular mortality worldwide. Effective management hinges on accurate risk stratification - classifying patients as high, intermediate, or low risk - to guide reperfusion strategies. This review evaluates the contemporary role of systemic thrombolysis, with a focus on the balance between rapid hemodynamic restoration and the risk of catastrophic hemorrhage. For high-risk PE characterized by hemodynamic instability, systemic thrombolysis remains the gold standard, offering a significant survival benefit that outweighs bleeding risks. Conversely, in intermediate-risk PE, it has been demonstrated that while full-dose thrombolysis prevents hemodynamic decompensation, it is associated with a significant increase in major bleeding and intracranial hemorrhage. Consequently, current guidelines generally support a "rescue thrombolysis" strategy rather than routine, up-front administration in this population. Encouragingly, recent small studies appear to demonstrate reduced-dose protocols that maintain efficacy while minimizing risk of major bleeding. While the acute effects of thrombolysis on hemodynamics are clear, there is conflicting evidence regarding the impact of thrombolysis on long-term sequelae such as chronic thromboembolic pulmonary hypertension (CTEPH). Ultimately, clinical decision-making must prioritize immediate hemodynamic risk while carefully evaluating contraindications to minimize adverse outcomes.

This paper reports a rare adult case of a 64-year-old female with interrupted pulmonary artery in the right middle and lower lobes, complicated by a branch aneurysm at the origin of the right subclavian artery. The patient was admitted for "depressed mood." And she experienced intermittent chest tightness and mild shortness of breath after physical activity. Elevated D-dimer levels were detected, and CT pulmonary angiography confirmed congenital interruption of the right middle and lower lobe pulmonary arteries, accompanied by extensive collateral circulation formation and pulmonary hypertension. This condition originates from abnormal development of the sixth aortic arch during embryogenesis and may clinically mimic chronic pulmonary embolism. Imaging evaluation is central to diagnosis, and treatment requires individualization: asymptomatic patients should undergo conservative follow-up, while those developing hemoptysis or progressive pulmonary hypertension may require interventional embolization or surgical intervention. This case underscores the need for vigilance regarding such rare vascular anomalies, where early recognition and long-term follow-up are crucial for improving patient prognosis.