Approach to a postoperative fever Quiz: Ace Your Exams

A 62-year-old woman is admitted to the hospital after undergoing an uncomplicated ventral hernia repair with mesh. On post-op day 2 the patient feels short of breath and is having incisional site pain. She has had a bowel movement and is passing gas. She does not have chest pain, nausea, vomiting, urinary urgency or dysuria. Her medical history is significant for a 30 pack-year smoking history, hypertension, and diabetes. Temperature is 100.6°F (38.1°C), blood pressure is 140/82 mmHg, pulse is 98/minute, respiratory rate is 22/minute, and oxygen saturation is 92% on room air. On pulmonary examination, the patient has increased work of breathing, crackles in the lung bases bilaterally and dullness to percussion. There is no significant abdominal tenderness, erythema, edema or purulent drainage around the incision site. Which of the following is the most likely cause of this patient’s current condition?