Paradoxical air embolism is certainly a possibility and has been reported after shoulder arthroscopic procedures in the sitting posture, but we feel that septic embolism could also be considered in differential diagnosis since this patient's preoperative diagnosis was hematogenous osteomyelitis with possible septicemia.

Osteomyelitis and septic arthritis are independent risk factors for septic embolism [2], and there have been cases reported after osteomyelitis [3]. Recurrent septic retinal emboli have also been reported following drainage of a dental abscess [4]. Transient bacteremia and paradoxical septic emboli were implicated as the probable cause of central retinal artery occlusion. Additionally, subclinical endocarditis cannot be ruled out, especially in the setting of septic hip arthritis, which could be a potential source of direct septic embolism.

We think that, besides air embolism, septic embolism should be considered in the differential diagnosis in a patient undergoing hip arthroscopy for a septic condition.