Acute pulmonary embolism (PE) is a common and often catastrophic disease. Early diagnosis and treatment of PE is im-portant, however, prompt diagnosis is difficult due to nonspecific clinical manifestations. On the other hand, syncope may develop as a presenting symptom of PE, and defecation activity could trigger PE. In Korea, PE associated with defecation has not been previously reported. We report on a case of acute massive PE presenting as defecation syncope in a 26-year-old female with a serous borderline tumor of the ovary.

Fatal pulmonary embolism occurs in 0.1% to 0.26% of cases of spine fusion surgery. Early diagnosis of pulmonary embolism is difficult, and delay in treatment can lead to a fatal outcome. We report on a case of symptomatic pulmonary embolism which developed after induction of general anesthesia in a patient who had been immobile because of a previous spinal operation one week prior to this. Despite a negative preoperative ultrasound examination for deep vein thrombosis, the patient had developed a pulmonary embolism, which was diagnosed using intraoperative transesophageal echocardiography. Despite intensive cardiopulmonary resuscitation and thrombolytic therapy, the patient died within a few hours of diagnosis.

Pulmonary embolism (PE) still has a high associated mortality. Anticoagulation should be continued until the benefit of preventing recurrent PE is outweighed by the risks of bleeding. Furthermore, D-dimer values and residual clot burden may predict recurrent thromboembolic events in patients that have completed anticoagulation therapy. The authors describe the case of a 69-year-old female who suffered multiple recurrent PE on aspirin, her medical history included idiopathic PE, and she had been on anticoagulant for a considerable time before switching to aspirin. It is important the possibility of recurrent PE be borne in mind to prevent secondary prevention, and that other treatment options be considered in cases of recurrent PE.