Death after adenotonsillectomy secondary to massive pulmonary embolism

Tonsillectomy is one of the most common surgical procedures performed in the United States. Although relatively safe, there is a small risk of post-operative mortality. The majority of deaths come from airway compromise or hemorrhage. The authors present a case of a 32-month-old child who underwent routine adenotonsillectomy for sleep disordered breathing and chronic pharyngitis who was found unresponsive and pulseless in his bed on the morning of postoperative day 2. The cause of death determined by post mortem autopsy was massive pulmonary embolism (PE). PE is a rare event in children and has never been reported as the cause of death following adenotonsillectomy in a child. This case is reviewed in addition to recent literature regarding obstructive sleep apnea (OSA) as a risk factor for venous thrombosis and PE.