A 72-year-old male patient was admitted to the orthopedic department of our hospital for an ankle fracture after a traffic accident injury in May 2021, without any related medical history. He underwent an open reduction and internal fixation for a fracture of the medial lateral and posterior ankle diagnosed by x-ray (Figure 1). Because it was a posterior ankle fracture, the patient was placed in a prone position and a posterolateral approach incision from the ankle was made. Approximately 1.5 h after the operation, the patient suddenly complained of chest pain and dyspnea. He was assisted in turning over to the supine position and was given oxygen immediately; venous access was established by a central venous catheter (CVC). The patient's dyspnea did not improve, and his blood pressure dropped rapidly. His heartbeat stopped and cardiopulmonary resuscitation (CPR) was performed. A pulmonary embolism caused by a blood clot was first considered for the typical presentation of dyspnea, decreased blood pressure, chest pain, and oxygen saturation, and 1.5x106 U urokinase was administrated. The patient's heartbeat did not recover. During a pause in performing CPR, we decided to take a chest x-ray and found the right heart and pulmonary artery full of air; the increase in the light transmittance of the visual field in both lungs was consistent with the characteristics of a pulmonary embolism (Figure 2). Air was also drawn from the CVC; VAE was then considered based on the imaging results, and the patient was treated conservatively by positioning him head down and tilted to the left (Durant's position) The CPR was continued. The patient's heartbeat recovered, and his blood pressure rose to a normal level. He was still unconscious and sent to the intensive care unit. Unfortunately, the patient was discharged from the hospital and died 24 h later. We suspect the patient died due to anoxia or heart-related complications. However, no autopsy was performed.